Treatment and survival analysis for 40-year SEER data on upper esophageal cancer

Xi Wu; Ming-Chuang Zhu; Guo-Liang Li; Peng Xiong; Wei Sun; Ni Zhang; Bo Zhao; Le-Qun Li; Xiang-Ning Fu; Min Zhu

doi:10.3389/fmed.2023.1128766

Treatment and survival analysis for 40-year SEER data on upper esophageal cancer

Front Med (Lausanne). 2023 Jul 17:10:1128766. doi: 10.3389/fmed.2023.1128766. eCollection 2023.

Authors

Xi Wu^#¹, Ming-Chuang Zhu^#², Guo-Liang Li³, Peng Xiong⁴, Wei Sun¹, Ni Zhang¹, Bo Zhao¹, Le-Qun Li¹, Xiang-Ning Fu¹, Min Zhu¹

Affiliations

¹ Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China.
³ Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
⁴ Intensive Care Unit, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

^# Contributed equally.

Abstract

Background: Upper esophageal cancer (UEC) is rare in both Eastern and Western countries. The epidemiological characteristics and long-term survival of UEC patients are less known. In addition, the choice of optimal treatment for UEC has been controversial.

Methods: Cases of UEC (C15.3 and C15.0) arising during the period from 1973 to 2013 were identified and selected using the SEER database. Student's t-test and Pearson's chi-square test were used to compare the differences in parameters among different groups. Esophageal cancer-specific survival (ECSS) and overall survival (OS) rates were calculated by using the Kaplan-Meier method. Cox proportional hazard regression was used to analyze predictive factors.

Results: In the past 40 years, the cases of UEC have gradually increased, and the proportion of adenocarcinoma (AD) has gradually increased (from 3.6% to 11.8%, p < 0.001). There has been a significant increase (1973-1982 vs. 2004-2013) in median OS (7 months vs. 10 months, p < 0.001) and median ECSS (7 months vs. 11 months, p < 0.001) among UEC patients from 1973 to 2013. For the impact of different treatments, the results showed that the ECSS and OS of surgery without radiation (SWR) and radiation plus surgery (R+S) were superior to those of radiation without surgery (RWS). Subgroup analysis showed that ECSS and OS were highest among patients treated with SWR compared with R+S and RWS for patients with localized disease. For regional disease, ECSS and OS were highest among patients with R+S compared with SWR or RWS. Among patients with regional-stage squamous cell carcinoma (SCC), OS was higher with neoadjuvant radiotherapy or adjuvant radiotherapy compared with SWR. Multivariate analysis showed that radiotherapy sequence was dependently associated with OS among patients with regional-stage SCC.

Conclusion: Although the long-term survival of UEC remains poor, it has gradually increased since 1973. This should be closely related to the improvement of medical care over the past 40 years. Different treatment methods have a great influence on the long-term survival of UEC. For localized diseases, surgery may be a better choice. For regional disease, surgery plus adjuvant or neoadjuvant radiotherapy may be more beneficial to improve the long-term prognosis of UEC patients.

Keywords: end results database; epidemiology; long-term survival; radiotherapy; surgery; the surveillance; upper esophageal cancer.

Grants and funding

This study was supported by grants from the National Natural Science Foundation of China (Grant No. 81172786), the Health Commission of Hubei Province scientific research project (No. WJ2019M146), and Funding from Tongji Hospital (No. 2016hgryzm).