Trends in treatment and overall survival among patients with proximal esophageal cancer

Judith de Vos-Geelen*, Sandra M. E. Geurts, Margreet van Putten, Liselot B. J. Valkenburg-van Iersel, Heike I. Grabsch, Nadia Haj Mohammad, Frank J. P. Hoebers, Chantal V. Hoge, Paul M. Jeene, Evelien J. M. de Jong, Hanneke W. M. van Laarhoven, Tom Rozema, Marije Slingerland, Vivianne C. G. Tjan-Heijnen, Grard A. P. Nieuwenhuijzen, Valery E. P. P. Lemmens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND

The management of proximal esophageal cancer differs from that of tumors located in the mid and lower part of the esophagus due to the close vicinity of vital structures. Non-surgical treatment options like radiotherapy and definitive chemoradiation (CRT) have been implemented. The trends in (non-)surgical treatment and its impact on overall survival (OS) in patients with proximal esophageal cancer are unclear, related to its rare disease status. To optimize treatment strategies and counseling of patients with proximal esophageal cancer, it is therefore essential to gain more insight through real-life studies.

AIM

To establish trends in treatment and OS in patients with proximal esophageal cancer.

METHODS

In this population-based study, patients with proximal esophageal cancer diagnosed between 1989 and 2014 were identified in the Netherlands Cancer Registry. The proximal esophagus consists of the cervical esophagus and the upper thoracic section, extending to 24 cm from the incisors. 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 of period of diagnosis on OS, adjusted for patient, tumor, and treatment characteristics.

RESULTS

In total, 2783 patients were included. Over the study period, the use of radiotherapy, resection, and CRT in non-metastatic disease changed from 53%, 23%, and 1% in 1989-1994 to 21%, 9%, and 49% in 2010-2014, respectively. In metastatic disease, the use of chemotherapy and radiotherapy increased over time. Median OS of the total population increased from 7.3 mo [95% confidence interval (CI): 6.4-8.1] in 1989-1994 to 9.5 mo (95%CI: 8.1-10.8) in 2010-2014 (logrank P <0.001). In non-metastatic disease, 5-year OS rates improved from 5% (95%CI: 3%-7%) in 1989-1994 to 13% (95%CI: 9%-17%) in 2010-2014 (logrank P <0.001). Multivariable regression analysis demonstrated a significant treatment effect over time on survival. In metastatic disease, median OS was 3.8 mo (95%CI: 2.5-5.1) in 1989-1994, and 5.1 mo (95%CI: 4.3-5.9) in 2010-2014 (logrank P = 0.26).

CONCLUSION

OS significantly improved in non-metastatic proximal esophageal cancer, likely to be associated with an increased use of CRT. Patterns in metastatic disease did not change significantly over time.

Original languageEnglish
Pages (from-to)6835-6846
Number of pages12
JournalWorld Journal of Gastroenterology
Volume25
Issue number47
DOIs
Publication statusPublished - 21 Dec 2019

Keywords

  • Esophagus
  • Esophageal cancer
  • Proximal
  • Cervical
  • Upper thoracic
  • Trends
  • Treatment
  • Survival
  • Outcome
  • SQUAMOUS-CELL CARCINOMA
  • CHEMOTHERAPY
  • RADIOTHERAPY
  • CHEMORADIOTHERAPY
  • NETHERLANDS
  • IMPROVEMENT
  • MORTALITY
  • SURGERY
  • VOLUME

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