B0216 - Lower Socioeconomic Status Is Associated With Higher Mortality in T1a Esophageal Cancer

Calvin X. Geng, MD¹, Anuragh R. Gudur, MD¹, Alexander Podboy, MD^2
1University of Virginia Health System, Charlottesville, VA; ²University of Virginia, Charlottesville, VA

Introduction: Esophageal cancer is the 6^th leading cause of cancer mortality worldwide. While esophagectomy remains the conventional treatment for early-stage esophageal cancer, minimally invasive endoscopic therapies have become an increasingly widespread alternative with comparable outcomes to surgery. Socioeconomic status (SES) has been linked to significant disparities in esophageal cancer. To date, the impact of SES on outcomes in early-stage esophageal cancer has not been evaluated. Our aim was to assess if socioeconomic status influences cancer-related outcomes in T1a disease.

Methods: Patients diagnosed with a primary T1a esophageal cancer from 2004-2015 via the November 2018 submission of Surveillance, Epidemiology, and End Results (SEER) Program were included. Demographic, tumor, treatment, and survival data were collected. Three tertiles of socioeconomic status were created based on patients’ median household income (MHI) from county-level data derived from 2010-2014 US Census. We compared all-cause, cancer-specific, and non-cancer related mortality at 2 and 5 years. Stratified survival distributions were assessed using the Kaplan–Meier method and clinical significance between survival curves was determined via the log-rank (Mantel–Cox) test. Statistical analysis was performed using R studio (R version 3.6.1, Boston, Massachusetts).

Results: A total of 1788 patients with primary T1a esophageal cancer from 2004-2015 were included. The three MHI groups were: lowest ($20,000 - $54,390), middle ($54,390 - $65,500), and highest ($65,500 - $106,520). 402 of these patients did not have complete follow up data, leaving 1386 patients for survival analysis. Patients with lowest income bracket had significantly lower overall survival at 2 (83% vs 91.5%, p=0.001) and 5 years (72.2% vs 81.1%, p=0.006), higher cancer-specific mortality at 2 (10.9% vs 5.3%, p=0.003) and 5 years (16.2% vs 10.9%, p=0.025), with similar levels of non-cancer related deaths at both 2 (p=0.102) and 5 years (p=0.147).

Discussion: In this population-level observational study, we demonstrate that lower median household income is associated with poorer cancer-specific and overall survival in esophageal cancer limited to the muscularis mucosa. Population-based strategies aimed at enhancing access to screening and identifying other possible etiologies for these socioeconomic disparities are paramount to improving patient outcomes in early esophageal cancer.




Disclosures:


Calvin X. Geng, MD¹, Anuragh R. Gudur, MD¹, Alexander Podboy, MD². B0216 - Lower Socioeconomic Status Is Associated With Higher Mortality in T1a Esophageal Cancer, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.