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Ann Thorac Surg 2001;72:1914-1917
© 2001 The Society of Thoracic Surgeons

Original article: general thoracic

Clinicopathologic characteristics of esophageal squamous cell carcinoma in younger patients

Tadahiro Nozoe, MD*a, Hiroshi Saeki, MDa, Takefumi Ohga, MDa, Keizo Sugimachi, MD, FACSa

a Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Accepted for publication July 12, 2001.

* Address reprint requests to Dr Nozoe, Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi Ward, Fukuoka, 812-8582, Japan
e-mail: nozoet{at}surg2.med.kyushu-u.ac.jp


   Abstract
Top
 Abstract
Introduction
 Patients and methods
 Results
 Comment
 References
 
Background. The aim of the current study was to find out the clinicopathologic characteristics of younger patients with squamous cell carcinoma of the esophagus.

Methods. A total of 259 patients with esophageal squamous cell carcinoma who had been treated by esophagectomy and reconstruction within 10 years between January 1990 and December 1999 were studied. Clinicopathologic characteristics were compared between 27 patients younger than 50 years and 232 patients 50 years and older.

Results. A significant difference was observed with regard to the size of the tumor (6.3 ± 3.8 cm in younger patients versus 5.0 ± 2.4 cm in older patients; p = 0.017). The proportion of patients with TNM stage III or IV in younger patients (59.3%, 16 of 27) was significantly higher than that in older patients (38.3%, 89 of 232; p = 0.020). Nevertheless, no significant difference in the 1-, 3-, and 5-year survival rates was observed between younger patients (77.2%, 54.7%, and 54.7%, respectively) and older patients (81.9%, 54.2%, and 48.8%, respectively).

Conclusions. Although the prognosis of younger patients with esophageal squamous cell carcinoma did not differ from that of older patients, esophageal squamous cell carcinoma in younger patients has more malignant potential and aggressive activity.


   Introduction
Top
 Abstract
 Introduction
Patients and methods
 Results
 Comment
 References
 
Malignant tumors have occasionally been reported to have a more aggressive potential in younger patients compared with that in older patients. However, whether the prognosis of younger patients with neoplasms is significantly worse than that in older patients remains controversial. Some reports emphasized the worse prognosis in younger patients with malignant tumors [1–9], whereas others emphasized the better prognosis of younger patients or the similar outcome irrespective of the age [10–16].

There have been a small number of studies on the relationship between the clinicopathologic characteristics and age of patients with esophageal carcinoma. Whether the prognosis of younger patients with esophageal carcinoma is more unfavorable than that in older patients also remains controversial [17–20].

In the current study, a clinicopathologic investigation was performed to find out the special characteristics of esophageal squamous cell carcinoma (SCC) in younger patients.


   Patients and methods
Top
 Abstract
 Introduction
 Patients and methods
Results
 Comment
 References
 
Patients
The subjects included 259 consecutive patients with esophageal SCC, who had been treated by esophageal resection and reconstruction from 1990 to 1999 in our institute. The patients comprised 224 men and 35 women. Twenty-seven patients younger than 50 years were classified as group Y and 232 patients 50 years and older were classified as group O. Ages of the patients in group Y ranged between 36 and 49 years, with a median age of 46 years, and ages in group O ranged between 50 and 89 years, with a median age of 65 years.

Follow-up was continued until death, and only patients who died of esophageal SCC were included in the tumor-related deaths. The interval of the follow-up after operation ranged from 25 days to 8 years 11 months with a mean of 2 years 7 months.

Preoperative therapies and surgical treatments are shown in Table 1. No significant difference was observed between the two groups.


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  		Table 1. Preoperative Therapies and Surgical Treatmentsa

 
Clinicopathologic characteristics and prognosis were compared between these patients. Pathologic features were presented according to the guidelines for clinical and pathologic studies on carcinoma of the esophagus established by the Japanese Society for Esophageal Diseases [21], and clinical stages were determined by TNM classification of malignant tumors prescribed by the International Union Against Cancer [22].

Statistical analysis
The {chi}2 test and Student’s t test were used to compare the clinicopathologic data. Cumulative survival rates were calculated by the Kaplan-Meier method, and survival curves were tested by the Mantel-Cox method. A p value of less than 0.05 was considered significant.


   Results
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 Abstract
 Introduction
 Patients and methods
 Results
Comment
 References
 
Clinicopathologic features are shown in Table 2. No significant difference in sex, location of tumors, and histologic types of the tumor was observed. A significant difference in the mean size of tumors was observed (6.3 ± 3.8 cm in group Y versus 5.0 ± 2.4 cm in group O; p = 0.017).


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  		Table 2. Clinicopathologic Featuresa,b

 
Although no significant difference was observed in the proportion of lymph node metastasis (37.0%, 10 of 27 in group Y, versus 43.5%, 101 of 232 in group O; p = 0.504), lymphatic invasion (25.9%, 7 of 27 in group Y, versus 26.7%, 62 of 232 in group O; p = 0.929), and venous invasion (18.5%, 5 of 27 in group Y, versus 16.4%, 38 of 232 in group O; p = 0.780), the proportion of patients with TNM stage III or IV in group Y (59.3%, 16 of 27) was significantly higher than that in group O (38.4%, 89 of 232; p = 0.020).

Operative variables are shown in Table 3. The operative period in group Y (368 ± 212 minutes) was significantly longer than that in group O (301 ± 139 minutes; p = 0.029). No significant difference was found regarding blood loss (723 ± 503 g in group Y versus 776 ± 479 g in group Y, p = 0.765) and intraoperative transfusion (29.6%, 8 of 27 in group Y, versus 34.1%, 79 of 232 in group O; p = 0.642).


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  		Table 3. Operative Period, Blood Loss, and Transfusiona,b

 
No significant difference was found in the incidence of postoperative complications (25.9%, 7 of 27 in group Y, versus 28.4%, 66 of 232 in group O; p = 0.869) and operative death (death within 30 days of surgical treatment; no patient in group Y versus 0.9%, 2 of 232 in group O; p = 0.628; Table 4).


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  		Table 4. Postoperative Complications and Operative Deatha

 
The 1-, 3-, and 5-year survival rates in group Y were 77.2%, 54.7%, and 54.7%, respectively, and the prognosis did not significantly differ from that of group O (81.9%, 54.2%, and 48.8%, respectively; p = 0.837; Fig 1).



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  		Fig 1. Kaplan-Meier survival curves. No significant difference was observed in prognosis between younger patients (group Y, thick line) and older patients (group O, thin line).

 

   Comment
Top
 Abstract
 Introduction
 Patients and methods
 Results
 Comment
References
 
Although some malignant tumors occasionally occur in the young in their 20s and 30s [1, 2, 23–25], the occurrence of esophageal carcinoma in such young people is rare; in the current study, only 0.8% (2 of 259) of the patients with esophageal SCC were younger than 40 years. Moreover, the malignant potential of neoplasms in younger patients has occasionally been reported to be much more aggressive than that in older patients. The prognosis of younger patients has been reported to be significantly worse than that in older patients in some reports with regard to gastric cancer [1, 2], colon cancer [3, 4], breast cancer [5, 6], and lung cancer [7–9]. However, there have also been some reports emphasizing that no significant difference is observed in prognosis between younger patients and older patients or that the prognosis of younger patients with neoplasm is better than that of older patients [10–16].

The occurrence of esophageal SCC in younger patients is comparatively rare, and therefore the number of reports on esophageal cancer in young patients is not necessarily large. It has been reported that the clinicopathologic characteristics of esophageal carcinoma in younger patients are not significantly different from those of older patients [17]. And especially regarding the prognosis, although Lu and colleagues [18] reported that the prognosis of younger patients (younger than 35 years) with esophageal carcinoma is significantly poorer than that of older patients, there have been some reports emphasizing that no significant difference is found in prognosis between younger and older patients with esophageal carcinoma [17, 19, 20].

In the current study, no significant difference was observed in prognosis between younger and older patients with esophageal SCC. However, the mean size of esophageal tumors in younger patients was significantly larger than that in older patients, and younger patients had significantly more-advanced tumors than older patients. The longer operative period in younger patients may be related to their advanced disease, requiring greater difficulty in the surgical procedure. These results indicated that the esophageal SCCs in the younger patients might have much more malignant potential and aggressive activity. This discrepancy may be interpreted as indicating that such elements in younger patients as the physical potential and nutritional condition [26, 27] could suppress the malignant potential of esophageal SCCs.

Similar results in some neoplasms have been reported. Lee and colleagues [10] reported that younger patients with carcinoma of the colon and rectum tend to present a more advanced stage, but that the survival is similar to that of older patients. Shimono and colleagues [16] reported that although younger patients with lung carcinoma tend to have a more advanced disease, the prognosis in younger patients does not differ from that in older patients.

Mori and colleagues [20] reported that rates of hospital death because of postoperative complications and operative death in younger patients with esophageal carcinoma are significantly lower than those in older patients. As the patients investigated in the current study were restricted to the cases with esophageal SCC who were surgically treated within the past 10 years, no significant difference in the incidence of postoperative complications was observed between younger and older patients, and operative death was found in only 2 older patients but not in any younger patients. The decrease in postoperative complications in surgical treatments for patients with esophageal carcinoma resulting in operative death must be related to improvement of perioperative management [28].

In conclusion, although the prognosis of younger patients with esophageal SCC did not differ from that of older patients, esophageal SCCs in younger patients are more advanced. In esophageal SCCs, some elements in younger patients might suppress the malignant potential of tumors.


   References
Top
 Abstract
 Introduction
 Patients and methods
 Results
 Comment
 References
 

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