Annals of Surgical Oncology· 2026Q1
Where You Live and Where You Are Treated: Addressing Disparities in Esophageal Adenocarcinoma
- 1citations
- Q1SCImago
- 2026year
Short summary
Treating esophageal adenocarcinoma (EAC) patients at high-volume centers (≥10 esophagectomies/year) significantly reduces survival disparities linked to socioeconomic status, with comparable 5-year survival rates (45.69% vs 46.20%) across high- and low-risk zip codes at these centers, unlike low-volume centers where disparities persist (36.80% vs 43.21%).
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Key points
- High-volume cancer centers (≥10 esophagectomies/year) showed comparable 5-year survival for EAC patients from high-risk (45.69%) and low-risk (46.20%) zip codes.
- Low-volume centers exhibited significant survival disparities, with high-risk zip code patients having worse 5-year survival (36.80%) than low-risk patients (43.21%).
- Overall, 38.2% of EAC patients resided in high-risk zip codes, and 87.1% were treated at low-volume centers.
- High-volume centers had slightly higher proportions of advanced disease but still offered better overall survival (44.97%) compared to low-volume centers (40.62%).
AI-generated from the title and abstract; the full text is not read.
Abstract
Abstract Background Lower socioeconomic status conveys a known survival disadvantage for patients with esophageal adenocarcinoma (EAC). The potential role of the treating center volume in mitigating this disparity has not been described to date. Methods Non-metastatic EAC patients were identified (NCDB 2012–2021). High- and low-risk zip code groups were derived from income and education quartiles. Center volume was delineated as “low” or “high,” with an annual threshold of ≥ 10 esophagectomies. Standard chi-square modeling, multivariable Cox hazard regression models, and Kaplan-Meier survival analyses were used where appropriate. Results Of 7462 EAC patients, 38.2% ( n = 2849) resided in high-risk zip code areas, and 87.1% were treated at low-volume centers. Clinical ( p = 0.230) and pathologic ( p = 0.992) staging distribution did not differ across zip codes. High-volume centers saw a slightly increased proportion of advanced disease ( p = 0.001). Patients at high-volume centers experienced better survival (5-year overall survival [5yOS], 44.97%) than their low-volume counterparts (5yOS, 40.62%) ( p < 0.001). Patients residing in high-risk zip code areas demonstrated worse 5yOS than their low-risk counterparts (38.20% vs 43.74%; p < 0.001). Evaluation of low-volume centers showed that the high-risk zip code group had shorter survival than their low-risk counterparts (36.80% vs 43.21%; p < 0.001). Interestingly, in high-volume centers, survival across zip code groups was notably comparable (45.69% vs 46.20%; p = 0.80). Conclusions Center expertise may offer an avenue for mitigating sociodemographic survival disparities in esophageal cancer. As discussions regarding centralized oncologic care continue, particular attention should be paid to the impact of high-volume center referral on the treatment of patients with social risk factors.
The authors' abstract, as published at the source. Annals of Surgical Oncology, 2026 · DOI ↗
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Field: Surgery
SurgeryMedicine