Forty years of experience with carcinoma of the esophagus at the Memorial Sloan-Kettering Cancer Center is reviewed. Of 1859 patients, 1529 were found to have epidermoid carcinoma and 45 had primary adenocarcinoma. Treatment and results in these 45 patients are discussed. Because of varying reports concerning the incidence and prognosis of adenocarcinoma of the esophagus, all cases of extension into the distal esophagus by a primary carcinoma of the stomach were carefully excluded. The two forms of esophageal cancer are compared and show a striking similarity in their clinical behavior and ultimate prognosis.
HE 'TKUE INCIDENCE A N D PROGNOSIS OF PRI-
T mary adenocarcinoma of the esophagus remain subjects of controversy. T h e indiscriminatc inclusion of lesions invading the lower esopliagus from the stomach accounts in part for the I d of agreement.
I n six reported series6 of malignant tumors of the esophagus totalling 1329 patients, 17 (I .3%,) were adenocarcinomas. Smithers'z collec.ted 26 cases from a total of 314, an incidence of 8y0, while Puestowl reported 10yo of 603 cases. Raphael et a1.8 reviewed 1312 patients with esophageal cancer seen at the Mayo Clinic from 1946 to 1963 and found 44 (3.3%) cases of primary adenocarcinoma. All but ten of these were discarded because of iriadequate histologic confirmation or erroneous inclusion of squamous and gastric lesions, reducing the incidence to 0.76%.
T h e records of all patients with nialignant tumors of the esophagus seen at Memorial-Sloan Kettering Cancer Center between 1926 and 1966 were reviewed. Those cases of adenocarcinonia proven to have arisen in the esophagus alone were studied and comparisons were made with a parallel study of epidermoicl carcinoma of the esophagus.
Results
Of 1859 patients with esophageal cancer, 45 were found to have primary adenocarcinoma, an incidence of 2.4% (Table 1). There From the Thoracic Service, Memorial Hospital for Cancer and Allied Diseases, 444 East 68th St., New Y'ork, N.Y. 10021.