S964 Trends in Incidence, Survival, and Emerging Therapies in Esophageal Cancer: A SEER-Based Analysis From 2000 to 2021

Introduction: Esophageal cancer remains a major global health concern, ranking among the top 10 most common cancers and sixth in cancer-related mortality. Esophageal squamous cell carcinoma (ESCC) predominates in developing countries, while esophageal adenocarcinoma (EAC) has risen in developed regions due to obesity, gastroesophageal reflux disease, and Barrett’s esophagus. Despite advances in therapy, most cases are diagnosed at advanced stages, resulting in poor overall survival. Understanding the evolving epidemiology and disparities in outcomes is essential to improving early detection and treatment. The aim of this article is to evaluate incidence trends, survival outcomes, and demographic disparities in ESCC and EAC using Surveillance, Epidemiology, and End Results (SEER) data from 2000 to 2021. Methods: A retrospective population-based analysis was conducted using SEER data from 2000-2021. Cases of esophageal cancer were stratified by histologic subtype, stage, sex, age, and race/ethnicity. Incidence trends and 1- and 3-year relative survival rates were calculated and compared across subgroups. Results: EAC incidence rose until the mid-2010s, particularly among non-Hispanic White men aged 50-75 years. ESCC incidence declined over the same period. In ESCC, 1-year survival was 60.1% (localized), 55.9% (regional), and 26.6% (distant), decreasing at 3 years to 37.7%, 31.2%, and 8.9%, respectively. For EAC, 3-year survival was higher in women (26.1%) than men (20.2%). Racial disparities were notable: Asian/Pacific Islanders (27.7%), Whites (24.2%), Hispanics (21.9%), American Indians/Alaska Natives (16.7%), and Blacks (16.4%). Survival also declined with age: <50 years (24.5%), 50-64 years (22.9%), and ≥65 years (21.7%). Conclusion: Although ESCC and EAC share a poor prognosis and late-stage detection, they differ in epidemiology, demographic distribution, and survival. EAC is increasing in developed countries and has lower long-term survival. ESCC remains lethal in resource-limited settings. Disparities in outcomes highlight inequities in healthcare access and diagnostic timing. While novel therapies, including immunotherapy and targeted agents, offer hope, their reach remains inconsistent. Advancing early diagnosis, equitable care, and biomarker-driven treatment is essential to improving prognosis and reducing the global burden of esophageal cancer.