Impact of prior cancer history on survival in patients with adenocarcinoma of esophagogastric junction: a retrospective cohort study using SEER database

Transl Cancer Res. 2026 Mar 31;15(3):188. doi: 10.21037/tcr-2025-2046. Epub 2026 Feb 27.

ABSTRACT

BACKGROUND: The exclusion of patients with prior malignancies from clinical trials remains controversial, yet its prognostic impact on adenocarcinoma of esophagogastric junction (AEG) is poorly characterized. This retrospective cohort study aimed to evaluate the prevalence and survival implications of prior cancer in AEG patients, providing evidence for refining trial eligibility criteria.

METHODS: The Surveillance, Epidemiology, and End Results databases were used to collect data between 1975 and 2021, and 10,895 AEG patients were included in the study. Inclusion required histologically confirmed AEG with complete follow-up data and only those with one prior cancer preceding the index AEG diagnosis to ensure temporal clarity. Prior cancers were classified according to their primary site, frequency, stage, and timing. Survival analyses included Kaplan-Meier curves, multivariate Cox regression, and competing risk models (Fine and Gray's). Propensity score matching was applied as a sensitivity analysis to validate the robustness of the primary findings.

RESULTS: Among 10,895 eligible patients, 16.58% (n=1,806) had prior cancer history and a median age of 67 years, with 79.20% male patients. The cohort showed significantly different overall survival (median 13 months for prior cancer vs. 16 months for no prior cancer). Disease stage distribution was: localized (18.40%), regional (28.80%), distant (29.30%), and unstaged (23.50%). The most common types of prior cancer were prostate (28.07%), and colon and cecum (11.13%). Additionally, 38.7% of the prior tumors were staged localized disease at prior cancer diagnosis. The median time period between detection of first and subsequent malignancies was 6.0 years. Patients with prior cancer were older (median age: 73 vs. 67 years) and had higher rates of localized AEG (23.30% vs. 17.50%, P<0.001) but lower chemotherapy utilization (46.50% vs. 57.50%, P<0.001) or radiation therapy (37.60% vs. 42.50%, P<0.001). Prior cancer was independently associated with worse overall survival [adjusted hazard ratio (HR) =1.16, 95% confidence interval (CI): 1.09-1.23, P<0.001] but not cancer-specific survival (HR =1.03, 95% CI: 0.96-1.10, P=0.43). However, Subgroup analyses revealed several patient populations where prior malignancy demonstrated no adverse prognostic impact. Patients with prior cancer diagnosed within 1 year showed comparable overall survival (HR =1.03, 95% CI: 0.91-1.15, P=0.67) and significantly better cancer-specific survival (HR =0.58, 95% CI: 0.49-0.68, P<0.001) in competing risk analysis. Those with localized-stage prior cancers exhibited no significant difference in cancer-specific survival (HR =0.91, 95% CI: 0.82-1.02, P=0.12). Notably, specific cancer types including breast (HR =1.00, 95% CI: 0.84-1.20, P=0.97), and lymphoma (HR =1.17, 95% CI: 0.89-1.54, P=0.27) showed neutral effects on overall survival.

CONCLUSIONS: While prior cancer history adversely impacts overall survival in AEG patients, specific subgroups-particularly those with select cancer types-exhibit comparable outcomes. These findings suggest that current exclusion criteria may be overly restrictive, and support refining trial eligibility to include well-selected prior-cancer patients.

PMID:41969437 | PMC:PMC13067036 | DOI:10.21037/tcr-2025-2046