A Comparison of Presenting Clinical Symptoms Between Patients With Distal Esophageal Adenocarcinoma and Those With Adenocarcinoma of the Gastroesophageal Junction

Introduction: Esophageal adenocarcinoma (EAC) and adenocarcinoma of the gastroesophageal junction (AGEJ) are often grouped together and treated similarly. While there exists notable heterogeneity in their oncogenic profiles, it remains unclear whether they possess distinct clinical presenting symptoms. To close this knowledge gap, after recent pilot data, we now present results of the entire study cohort comparing clinical symptoms between AGEJ and EAC at diagnosis. Methods: This is a retrospective study of patients with proven gastroesophageal cancers treated within the VA Boston Healthcare System over a 20-year period. Patients were grouped into EAC or AGEJ based on the TCGA criteria using tumor epicenter location. All relevant clinical-pathological data were extracted from charts and tabulated using student t-test, Chi square and Fisher exact test. We examined presenting clinical symptoms at diagnosis and OS was estimated with the Kaplan-Meier methods. Results: A total of 317 subjects were enrolled in this study with 62 EAC and 255 AGEJ cases. Basic demographics of EAC and AGEJ patients did not differ with respect to age, race, and BMI (Table 1). Almost all patients were male in this Veteran population. The most common presenting symptoms were dysphagia (51%) and weight loss (40%), which were numerically but not statistically significant between the 2 groups (Table 1). However, a past medical history of GERD was significantly associated with EAC (P=0.008). None of the other presenting symptoms including anemia, nausea, vomiting, early satiety, overt bleeding signs, and abdominal pain were statistically significant and occurred in less than 12% of patients. There were 12 (20%) and 15 (6%) asymptomatic EAC and AGEJ patients (P=0.07), respectively. Conclusion: While patients with EAC have improved survival outcomes as compared to AGEJ, suggesting oncogenic heterogeneity in these cancers with different pathogenesis mechanisms, their presenting clinical symptoms are similar in this large study except past medical history of GERD. Lead time bias could contribute to this discrepancy as EAC patients were also more likely to be diagnosed on surveillance endoscopy (though not statistically significant). Subgroup analysis and exclusion of surveillance endoscopy in large studies could further characterize these differences. This study also highlights the importance of accurate diagnosis in tumor location in the distal esophagus and GEJ region, which will help better manage these patients clinically. Table 1. - Basic demographic characteristics and chief clinical complaints at presentation of 2 groups of carcinomas in distal esophageal adenocarcinoma (EAC, N=62) and adenocarcinoma of the gastroesophageal junction (AGEJ, N=255) ranked by frequency in the entire cohort (N=317) Characteristics All (N=317) EAC (N=62) AGEJ (N=255) P value age at diagnosis, yrs+STDEV 69+9 68+9 69+9 NS Male sex, n (%) 316 (100) 62 (100) 254 (100) NS BMI (KG/m2) at diagnosis, mean+STDEV 28+7 28+7 28+7 NS White race, n (%) 247 (78) 49 (79) 198 (78) NS Chief Complaints at Presentation All (N=317) EAC (N=62) AGEJ (N=255) P value Dysphagia, n (%) 161 (51) 23 (37) 138 (54) 0.26 Weight loss, n (%) 128 (41) 18 (29) 110 (43) 0.28 PMHx GERD, n (%) 93 (30) 29 (47) 64 (25) 0.008 Abdominal pain, n (%) 40 (13) 4 (6) 36 (14) 0.29 Vomiting, n (%) 32 (10) 4 (6) 28 (11) 0.53 Iron deficiency anemia, n (%) 29 (9) 8 (13) 21 (8) 0.34 Asymptomatic, n (%) 27 (9) 12 (20) 15 (6) 0.07 Overt bleeding, n (%) 36 (11) 5 (8) 31 (12) Melena, n (%) 25 (8) 3 (5) 22 (9) 0.25 Hematochezia, n (%) 5 (2) 0 (0) 5 (2) 0.99 Hematemesis, n (%) 6 (2) 2 (3) 4 (2) 0.50 Shown are only the most common clinical symptoms. Only a past medical history (PMH) of GERD was significantly associated with risk for EAC (P=0.008). There was no difference between the demographic characteristics of both groups comprised of a Veteran population.