Epidemiology and Survival of Esophageal Cancer Patients in an American Cohort

Abstract

ObjectivesThis study seeks to delineate trends in esophageal cancer patients in an American cohort and, in particular, examine the impact of race and histology on survival.MethodsThe association between over 50 variables between histology and race subgroups was evaluated. Survival was calculated using Kaplan-Meier curves and a multivariable Cox regression analysis (MVA) was performed.ResultsPoorer survival was noted in black vs. white (193 ± 65 days vs. 254 ± 39, 95% CI 205-295, p=0.07) and squamous cell cancer (SCC) vs. adenocarcinoma (AC) (233 ± 24 days vs. 303 ± 48, 95% CI 197-339, p=0.01) patients. In patients with resectable cancer, blacks had poorer survival than whites (253 ± 46 days vs. 538 ± 202, 95% CI 269-603, p=0.03), and SCC had poorer survival than AC (333 ± 58 vs. 638 ± 152 days, 95% CI 306-634, p=0.006). A higher percentage of white patients received surgery compared to black patients (36% vs. 8%, p=0.08). MVA revealed that only surgery was an independent predictor of mortality (p=0.001).ConclusionBlack race and SCC were associated with poorer survival. On MVA, surgery was an independent predictor of mortality. Clinicians should be aggressive in offering potentially curative procedures to patients and eliminating socioeconomic barriers.

Perfil dos Pacientes com Câncer de Esôfago Diagnosticados entre 2001 e 2010 no Brasil

“…O tipo histológico mais frequente é o carcinoma de células escamosas (CCE); porém, estudos internacionais mostram diminuição gradativa na incidência desse tipo de tumor, e elevação na frequência de adenocarcinoma [3][4][5][6][7] .…”

“…Com o intuito de aumentar a sobrevida e minimizar as complicações do tratamento, estratégias utilizando a radioterapia e a combinação de radioterapia à quimioterapia têm despertado o interesse da comunidade científica [10][11] . Entretanto, apesar do progresso nos últimos anos no tratamento do câncer de esôfago, a sobrevida dos pacientes, mesmo após ressecção completa, continua muito baixa, em razão do estádio avançado da doença ao diagnóstico [3][4][12][13][14] . Esse fato acontece, principalmente, por causa dos sinais do câncer só ocorrerem quando o tumor atingir volume suficiente para causar sintomas obstrutivos.…”

Neoadjuvant strategies in resectable carcinoma esophagus: a meta-analysis of randomized trials

“…They concluded that adjuvant RT is associated with a significantly lower death risk hazard ratio (0.84 95%CI 0.73-97, p = 0.016) and disease-specific death risk hazard ratio (0.84 95%CI 0.72-0.97, p = .02). On multivariate analysis in an epidemiological study by Nassri et al [42], it was shown that the only significant factor which benefits survival is esophagectomy, i.e., the surgery itself. They reported that 16% of patients on neoadjuvant treatment had disease progression, and only 41% underwent definitive surgery.…”

Short-Course 2-Dimensional Radiation Therapy in the Palliative Treatment of Esophageal Cancer in a Developing Country: A Phase II Study (Sharon Project)

“…Esophageal cancer (ECa) is an extremely aggressive malignancy, and more than 50% of patients present with a locally advanced or metastatic disease at diagnosis. 1,2 Currently, there is no clear standard of care for these patients. However, patients with locally advanced disease that is not suitable for surgery or chemoradiation, or those in poor clinical condition with multiple comorbidities, could still benefit from palliative treatment.…”

“…[3][4][5][6] Dysphagia, chest pain, gastrointestinal bleeding, asthenia, weight loss, fever, nausea, and vomiting are the most frequent symptoms, which worsen quality of life. 2,[7][8][9] Moreover, dysphagia can also dramatically reduce nutritional support and lead to malnutrition, anorexia, and dehydration. 10 Several effective options, such as intraluminal stents, brachytherapy, and endoscopic treatment of obstruction or stenosis with laser or cryotherapy, are available for symptom palliation.…”