Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7708
Peer-review started: September 15, 2021
First decision: October 18, 2021
Revised: November 30, 2021
Accepted: June 24, 2022
Article in press: June 24, 2022
Published online: August 6, 2022
Esophageal cancer is the ninth cancer worldwide in terms of incidence but the sixth in mortality. The prognosis of esophageal cancer is poor.
The factors influencing the prognosis of patients with esophageal cancer vary among studies and are still poorly known. Some predictive models are available, but their value is limited.
This study aimed to determine the factors related to the survival of patients with esophageal cancer.
This retrospective study included patients with esophageal cancer admitted between January 2017 and March 2020 at Heping Hospital Affiliated to Changzhi Medical College. All patients were treated according to the available guidelines. Follow-up was censored in October 2020. Univariable and multivariable Cox regression analyses were used to determine the independent risk factors for overall survival (OS).
Among 307 patients, the in-hospital mortality was 16.9%, the 30-day mortality was 19.9%, and the 90-day mortality was 25.4%. The patients showed a cumulative OS rate at the last follow-up of 82.1% (95%CI: 67.7%-96.5%) for stage 0/I/II and 47.4% (95%CI: 16.5%-78.6%) for stage III/IVA (P < 0.001). Creatinine levels (HR = 1.02, 95%CI: 1.00-1.03, P = 0.050), pTNM III/IVA (HR = 4.19, 95%CI: 2.19-8.01, P < 0.001), adjuvant radiotherapy and/or chemotherapy (HR = 0.23, 95%CI: 0.11-0.49), and the Comprehensive Complication Index (CCI) (HR = 1.02, 95%CI: 1.004-1.03, P = 0.011) were independently associated with OS.
The survival of patients with esophageal cancer is poor, especially those with pTNM III/IVA. pTNM stage III/IVA, CCI, and adjuvant therapy (radiotherapy and/or chemotherapy) are independently associated with OS. These results could help manage patients by identifying those needing closer follow-up.
These results could help delineate the factors associated with poor survival in patients with esophageal cancer. Identification of the factors that could help refine prognostication is important since two patients with the same histological grade and TNM staging can have different survival. These results should be validated in large cohorts of patients from multiple centers.