Incidence Trends and Survival in Early-Onset Esophagogastric Adenocarcinoma: A Swedish Population-Based Cohort Study

Abstract Background: Early-onset adenocarcinomas of different sites are increasing in high-income countries, data on esophagogastric adenocarcinoma are sparse. Methods: We performed a Swedish population-based cohort study over 1993 to 2019 to delineate differences in incidence and survival in early-onset (age 20–54 years) compared with later-onset (55–99 years) esophageal, cardia, and noncardia gastric adenocarcinoma. Temporal incidence trends were quantified as annual percentage changes (APC) and survival differences as excess mortality rate ratios (EMRR) using Poisson regression and including 95% confidence intervals (CI). Results: Among 27,854 patients with esophagogastric adenocarcinoma, 2,576 were early-onset whereof 470 were esophageal, 645 were cardia, and 1,461 were noncardia gastric. Except noncardia gastric, the male predominance was larger in early-onset compared with later-onset disease. Advanced stage and signet ring cell morphology were more common among early-onset patients. Early-onset and later-onset APC estimates were comparable and esophageal adenocarcinoma incidence increased, cardia remained stable, and noncardia gastric decreased. Early-onset patients had better survival than later-onset, which was amplified when adjusting for prognostic factors including stage [adjusted EMRR 0.73 (95% CI, 0.63–0.85) in esophageal, 0.75 (95% CI, 0.65–0.86) in cardia, and 0.67 (95% CI, 0.61–0.74) in noncardia gastric adenocarcinoma]. The early-onset survival advantage was more pronounced in localized stages 0 to II (all sites) and women (esophageal and noncardia gastric). Conclusions: We found no major differences in incidence trends comparing early-onset and later-onset esophagogastric adenocarcinoma. Despite unfavorable prognostic features, early-onset esophagogastric adenocarcinoma survival was better than later-onset, particularly in localized stages and women. Impact: Our findings suggest delayed diagnosis in younger individuals and especially men.