Improved survival in both histologic types of oesophageal cancer in Sweden

Abstract

The prognosis among patients diagnosed with oesophageal cancer is poor with an overall 5-year survival close to 5% in most countries. Improved diagnostic and surgical strategies might influence the survival, however. We investigated the observed and relative survival among all patients in Sweden diagnosed with oesophageal adenocarcinoma (n ‫؍‬ 1,441) or squamous cell carcinoma (n ‫؍‬ 6395) from 1961-1996 with follow-up to December 1997. Observed survival rates were calculated by the life-table method. Relative survival rates were computed as the ratio of the observed to the expected survival. The expected survival was inferred from the survival among the entire Swedish population in the same age, sex and calendar year strata. The 5-year observed survival rate for adenocarcinoma increased from a stable figure close to 4% during the entire period 1961-1989 to 10.5% during 1990 -1996. Similarly, the 5-year relative survival rate was stable around 5% during 1961-1989, but during 1990 -1996 the survival was increased to 13.7%. For squamous cell carcinoma, the survival improved slightly by each decade, starting with 3.8% 5-year observed survival in 1961-1969 to 7.0% during 1990 -1996. Similarly, the 5-year relative survival improved from 5.0% to 8.9% during the study period. In conclusion, the survival rates for both oesophageal adenocarcinoma and squamous cell carcinoma have increased significantly during the 1990s compared to those in the previous 3 decades (p < 0.001). © 2002 Wiley-Liss, Inc. Key words: oesophageal cancer; survival; mortality; neoplasm; oesophagus; SwedenOesophageal cancer is a highly lethal malignancy. The previously reported 5-year survival rate of close to 5% for both histologic types, i.e., adenocarcinoma and squamous cell carcinoma, is worse than that of most other malignancies. 1 Surgical resection is the only established curative treatment for oesophageal cancer. Several randomised clinical trials trying adjuvant therapy have been conducted, but the results have generally been disappointing. There is currently no evidence of an increased long-term survival as a result of the use of adjuvant chemotherapy or radiotherapy. 2,3 In recent decades there has been a rapid increase in the incidence of oesophageal adenocarcinoma in Western countries, whereas the incidence of squamous cell carcinoma of the oesophagus has been stable or decreasing. 4,5 Most oesophageal adenocarcinomas develop from BarrettЈs oesophagus, a columnar cell metaplasia of the native distal oesophageal squamous cell mucosa, easily detectable at endoscopy and verified by histology. 6 The strong association with oesophageal adenocarcinoma has prompted calls for introduction of endoscopic surveillance programs for early detection of adenocarcinoma among persons with BarrettЈs oesophagus, 7 although cost-effectiveness should be taken into account. 8

Epidemiology of esophageal adenocarcinoma

“…Comparing survival among the entire Swedish population in the same age, sex, and calendar year strata, they verified that 5-year survival rate and 5-year relative survival rate for ACE increased from a stable figure close to 4% and 5% during 1961-1989, respectively, to 10.5% and 13.7% during 1990-1996, respectively [32]. In a more recent study, Polednak et al [33], using a computer program that included mortality rates for the general population and relative survival rates for patients with ACE and SCC, verified an increase in relative survival rates for ACE and esophageal SCC, and for both males and females from 1975-1979 to 1995-1998, 3-year relative survival rates increased from 10.3% to 20.7% in males, and from 6.6% to 18.6% in females for ACE.…”

Long-term weight change after oesophageal cancer surgery

“…The choice of follow-up times was based on the knowledge that acute problems would have abated 6 months after surgery, the risk of recurrent disease would be low 7,15 and the chance of cure would be high after 3 years 16 . Local tumour recurrence may influence weight loss, particularly as a result of dysphagia, so to avoid this problem the study was restricted to patients who had clear resection margins.…”

Trends in oesophageal cancer incidence and mortality in Europe

“…33 Oesophageal cancer trends are also influenced by improvements in diagnosis and disease management. Although the prognosis of oesophageal cancer has been poor-with a relative survival of between 5 and 10% up to the 1980s-some recent data showed the existence of appreciable improvements for both histologic types of oesophageal cancer over the last decades, [34][35][36][37][38] probably as a consequence of earlier diagnosis and detection through wider adoption of endoscopy, as well as to advancements in treatment of the disease. The impact of such improvements on oesophageal cancer mortality is, however, difficult to evaluate.…”