Published online Dec 21, 2019. doi: 10.3748/wjg.v25.i47.6835
Peer-review started: October 16, 2019
First decision: November 10, 2019
Revised: December 4, 2019
Accepted: December 14, 2019
Article in press: December 14, 2019
Published online: December 21, 2019
Proximal esophageal cancer is a rare disease, accounting for only 10% of all esophageal cancers. Nearby vital structures are involved in almost all proximal esophageal cancers at diagnosis, and as such surgical treatment is mutilating with major implications for quality of life of patients. Definitive chemoradiation (CRT) is an alternative treatment option, but survival data are scarce, restricting patient counseling.
To optimize treatment strategies and counseling of patients with proximal esophageal cancer, it is therefore essential to gain more insight in patient characteristics, provided therapies and outcome through real-life studies.
The aim of this population-based cohort study was to establish the trends in treatment and overall survival (OS) in patients diagnosed with non-metastatic or metastatic proximal esophageal cancer in a nationwide registry between 1989 and 2014.
All patients with a tumor located in the cervical or upper thoracic esophagus diagnosed between 1989 and 2014 were identified in the Netherlands Cancer Registry (NCR). The NCR is a population-based cancer registry of all residents of the Netherlands. Trends in radiotherapy, chemotherapy, and surgery, and OS were assessed. Analyses were stratified by presence of distant metastasis. Multivariable Cox proportional hazards regression analyses was performed to assess the effect f period of diagnosis on OS, adjusted for adjust for patient, tumor, and treatment characteristics.
Median OS of patients with proximal esophageal cancer significantly increased by approximately two mo between 1989 and 2014. In patients with non-metastatic proximal esophageal cancer, 5-year OS almost tripled to 13% in 2010-2014, although the absolute longterm outcome remains poor. Multivariable analysis showed that improvements in treatment over time have led to this survival benefit. The improvement is likely to be attributable to the implementation of CRT in the late nineties, accounting for almost 50% of treatment choices in non-metastatic proximal esophageal cancer nowadays, as shown in the current study. In metastatic disease, median OS did not change significantly between 1989 and 2014.
Surgical treatment for proximal esophageal cancer has been substituted by definitive CRT in the more recent years, and was likely to be associated with significant survival improvement of patients with non-metastatic proximal esophageal cancer. (Long-term) survival data of patients with (non-)metastatic proximal esophageal cancer are provided from a large national database, representing daily clinical practice.
Our findings give insights in real-life survival of patients with proximal esophageal cancer, providing crucial support for patient counseling. Future research should focuss on outcome between different CRT regimens, to optimize non-surgical treatment.