Adenosquamous Carcinoma of the Esophagus: An NCDB-Based Investigation on Comparative Features and Overall Survival in a Rare Tumor

Abstract

Objectives: Esophageal adenosquamous carcinoma (ASC) is a rare tumor with characteristics of adenocarcinoma (AC) and squamous cell carcinoma (SCC), the two most common esophageal cancers. Its behavior is aggressive but poorly understood. Using the National Cancer Database (NCDB), the clinical features and overall survival of ASC were compared with AC and SCC. Methods: The NCDB was queried for patients with esophageal ASC, AC, and SCC. Univariate association of histology with patient characteristics and overall survival were analyzed and socioeconomic characteristics were balanced. Results: Clinical M stage was 0 in a significantly lower proportion of ASC (69.0%) than in AC (70.9%) or SCC (75.6%) (p < 0.001). Median survival was lower in patients with ASC (9.6 months) than with AC (13.5) or SCC (9.7) and 2-year OS was lower in patients with ASC (23.8%) than with AC (34.6%) or SCC (26.5%) (p < 0.001). The OS hazard ratio for ASC was 1.14 when compared to AC (95% CI = 1.016-1.267, p = 0.025) and 1.10 when compared to SCC, but the latter was not significant (95% CI = 0.980-1.222, p = 0.111). Conclusion: ASC is a rare tumor among esophageal carcinomas with a greater burden of metastatic disease than AC or SCC and worse OS than AC.

Adenosquamous carcinoma of the esophagus: A literature review

“…In some studies, ASC mainly presented in the middle esophagus,[ 3 , 6 , 7 ] which is the area where SCC is most commonly found. [ 25 ] In contrast, others reported the distal esophagus as being more frequently affected,[ 4 , 8 , 9 ] thus resembling the distribution pattern of AC. [ 25 ]…”

“…ASC is a rare type of esophageal cancer. In patient series from both Asia[ 3 , 4 , 5 , 6 , 7 ] and the US,[ 8 , 9 ] the reported incidence rates range between 0.37%[5] and 1%. [ 3 , 7 , 9 ] The age and gender distribution is also consistent throughout the literature.…”

“…ASC mostly presents in people older than 40 years, with incidence peaking around the 7th decade of life. Men are more frequently affected than women, with male-to-female ratios ranging from 4:1[ 8 ] to 8:1. [ 4 ]…”

“…[ 3 , 4 , 5 , 7 , 9 ] In the same way, the data regarding the distribution of patients in different pT and pN stages are contradicting. [ 3 , 4 , 5 , 6 , 7 , 8 ] When it comes to Tumor Grade, several studies showed that ASC are more commonly higher grade tumors (poorly differentiated or undifferentiated) than lower grade. [ 3 , 5 , 9 ] Finally, Yendamuri et a1 .…”

“…[ 3 , 4 , 5 , 6 , 7 ] Only recently did larger case series emerge. [ 8 , 9 ] The purpose of this review is to summarize the existing data on epidemiology, pathogenesis, histopathology, clinical characteristics, diagnosis and staging of ASC, as well as treatment and prognosis.…”