S926 Disparities in Metastasis and 5-Year Survival in Asian Patients With Upper Esophageal Carcinoma

Introduction: Esophageal squamous cell carcinoma (ESCC) disproportionately affects Asian populations and frequently arises in the upper esophagus. Despite known epidemiologic differences, real-world data comparing metastasis and long-term survival by race are limited. This study aims to assess disparities in metastasis and 5-year survival between Asian and White patients with upper esophageal cancer using a multi-institutional electronic health record network. Methods: We performed a retrospective cohort study using the TriNetX Research Network. Adults (≥18 years) with upper esophageal cancer were identified using International Classification of Diseases (ICD)-10-CM and ICD-O codes. Patients were stratified by race and 1:1 propensity score matched by age, sex, and ethnicity. Sex-stratified analyses were not matched by sex. Metastasis was identified using ICD-10 codes for secondary malignancies. Survival was analyzed using Kaplan-Meier methods. Hazard ratios (HR), risk ratios (RR), odds ratios (OR), and 95% confidence intervals (CIs) were calculated. Results: Asian patients had significantly higher rates of metastasis (RR 1.84; OR 2.80; P < 0.0001) and lower 5-year survival (27.6% vs 41.6%; HR 1.42; P < 0.0001) compared to matched White patients. Among men, metastasis occurred in 54.4% of Asian vs 29.9% of White patients, with corresponding 5-year survival of 26.0% vs 38.8% (P < 0.0001). Among women, metastasis was more common in Asians (33.9% vs 18.3%), but 5-year survival did not differ significantly (40.7% vs 50.2%, P = 0.6225). Among those with metastasis, survival between racial groups was not significantly different (0% vs 16.7%; P = 0.7585). Similarly, among non-metastatic patients, survival was higher for Asians (56.6% vs 41.4%; P = 0.2672), though not statistically significant. Conclusion: Asian patients, especially men, with upper esophageal cancer experience significantly higher metastatic burden and poorer survival than White patients. These findings may reflect biological, behavioral, or systemic contributors and underscore the need for culturally tailored screening and early intervention strategies in high-risk populations.