A Survival Comparison of Mucin-Producing Adenocarcinoma of the Esophagus to Conventional Adenocarcinoma after Esophagectomy

The objective of this study was to test the hypothesis that mucin-producing adenocarcinoma (MA) exhibits a more advanced clinical presentation and worse prognosis than conventional adenocarcinoma (CA) in patients undergoing esophagectomy. Patient demographic and clinical variables and cancer-specific survival were collected from the U.S. Surveillance Epidemiology and End Results database between 1988 and 2006. Esophagectomy was performed for 105 patients with MA and 5473 patients with CA. The MA cohort exhibited a similar age at presentation, gender, and anatomic location (lower third of the esophagus/abdominal) as the CA cohort. We found trends toward advanced pathologic stage of disease of MA compared with CA (Stage IIB to IV 56 vs 46%), higher grade tumors (Grade III/IV, 44 vs 34%), positive lymph nodes (51 vs 40%), and poorer mean survival. For both groups, after multivariate analysis, age at diagnosis, tumor stage, and grade were negative predictors of survival (hazard ratios 1.02, 1.39, and 1.32, respectively; P < 0.001). Although this study suggests that patients with resected MA of the esophagus have a trend toward worse clinical presentation and survival than patients with resected CA, the observations are not significant and do not support our hypothesis or results from single-institution studies.