Long-term survival trends in GI cancer: Demographic and socioeconomic influences.

810 Background: Gastrointestinal (GI) cancers including esophageal, gastric, colorectal, hepatobiliary, and pancreatic malignancies are among the leading causes of cancer-related morbidity and mortality worldwide. According to the 2020 GLOBOCAN report, one in every sixteen persons globally will die from GI cancer at some point in their lives. Even with the advancements in diagnostics and treatments, there are still substantial disparities in survival outcomes based on cancer subtype, age, sex, and socioeconomic status. Only a small number of studies have thoroughly investigated survival trends in the U. S. population stratified by age, sex, income, and follow-up time. Methods: Survival data were extracted from the SEER (Surveillance, Epidemiology, and End Results) database for patients diagnosed with GI cancers between 2000 and 2023. Analyses were stratified by age (<60, 60–69, ≥70 years), sex (male vs female), and income (<40, 000 to ≥120, 000). Survival outcomes were assessed at 12, 24, 36, 48, and 60 months. Age-adjusted comparisons across cancer subtypes and subgroups were performed to evaluate long-term trends and disparities. Results: More than 450, 000 patients with GI cancers were included. There were significant differences in survival trends by type of cancer, age, sex, income, and length of follow-up. Colorectal cancer demonstrated the most favorable long-term survival, while pancreatic and esophageal cancers showed the steepest declines, with <20% survival after 24 months. Patients <60 years consistently had the highest survival across all cancer types, whereas those ≥70 years had the lowest. The longer the follow-up, the wider the age-specific survival disparity. Women generally outlived men across most cancer types, though pancreatic cancer remained poor in both sexes. Higher income was consistently associated with improved survival: patients in the ≥85, 000 category had significantly better outcomes than those earning <40, 000. Even in poor-prognosis cancers such as the pancreas, higher income conferred measurable benefits. At 12 months, survival differences by sex and income were modest. Still, by 60 months, the curves diverged sharply, suggesting that socioeconomic status has a stronger impact on long-term than short-term survival. Conclusions: The survival outcomes for the major GI malignancies in the United States are greatly impacted by age, sex, socioeconomic level, and cancer type. The prognosis for colorectal cancer is the best, but that for pancreatic and gallbladder malignancies remains low. While lower income is linked to disproportionately worse long-term survival across almost all GI cancers, younger patients and women consistently have survival advantages. These findings underscore the need for targeted interventions to reduce socioeconomic disparities in cancer care, with a focus on elder and low-income groups' resource allocation and survivorship support.