Clinical Characteristics and Prognosis of Esophageal Squamous Cell Carcinoma in Patients Under 60 Years of Age

<b>Background:</b> Esophageal squamous cell carcinoma (ESCC) typically occurs in older individuals. The etiology and clinical characteristics of ESCC in relatively younger patients under 60 years of age remain unclear. Understanding whether age affects tumor behavior or prognosis is important for improving patient management. This study aimed to analyze the characteristics of ESCC diagnosed before the age of 60. <b>Methods:</b> We retrospectively reviewed the medical records of ESCC patients diagnosed between December 2008 and May 2025. A total of 516 patients were divided into two groups based on whether they were aged 60 or above. Medical history, clinical features, and outcomes were compared between the two groups. <b>Results:</b> There were 100 patients under 60 years and 416 patients aged 60 and above. The median ages were 55 (range 41-59) and 72 (range 60-95), respectively. Younger patients had a significantly stronger association with heavy drinking (72.0% vs. 39.2%, <i>p</i> < 0.001) and smoking (76.0% vs. 55.0%, <i>p</i> < 0.001). There was a trend toward more advanced disease (Stage IV: 26.0% vs. 18.5%, <i>p</i> = 0.094) and metastatic presentation (18.0% vs. 13.9%, <i>p</i> = 0.305) in the under-60 group. Despite being younger with better performance status and fewer comorbidities, their overall survival did not differ from that of older patients (HR 0.92; 95% CI, 0.67-1.26; <i>p</i> = 0.593). <b>Conclusions:</b> Patients diagnosed with ESCC under the age of 60 showed a stronger association with heavy alcohol consumption and smoking and more frequent presentation with advanced-stage disease compared with older patients. Younger age did not confer a better prognosis, highlighting the importance of early detection and timely intervention regardless of patient age.