The influence of prediagnostic demographic and lifestyle factors on esophageal squamous cell carcinoma survival

Abstract

Demographic and lifestyle factors, in particular tobacco smoking and alcohol, are well established causes of esophageal squamous cell carcinoma (ESCC); however, little is known about the effect of these factors on survival. We included all 301 patients with incident ESCC, recruited into a population-based case-control study of esophageal cancer in Australia. Detailed information about demographic and lifestyle factors was obtained at diagnosis, and deaths were identified using the National Death Index. Median follow-up for all-cause mortality was 6.4 years. Hazard ratios (HRs) and 95% confidence intervals (95% CI) were calculated from Cox proportional hazards models, adjusted for age, sex, pretreatment AJCC tumor stage, treatment and presence of comorbidities. Two hundred and thirteen patients (71%) died during follow-up. High lifetime alcohol consumption was independently associated with poor survival. Relative to life-long nondrinkers and those consuming <1 drink/week, the HRs for those with average consumption of 7-20 drinks/week or 21 drinks/week were 2.21 (95% CI 5 1.27-3.84) and 2.08 (95% CI 5 1.18-3.69), respectively. There was a suggestion of worse survival among current smokers (HR 5 1.42, 95% CI 5 0.89-2.28); however, the risk of early death was greatest among current smokers who reported regularly (7 drinks/week) consuming alcohol (HR 5 3.84, 95% CI 5 2.02-7.32). Other lifestyle factors putatively associated with risk of developing ESCC were not associated with survival. In addition to increasing disease risk, heavy alcohol consumption may be independently associated with worse survival among patients with ESCC. Future clinical follow-up studies should consider alcohol as a potential prognosticator, in addition to known clinicopathologic factors.Esophageal cancer is the sixth leading cause of cancer mortality worldwide.1 According to the most recent global estimates, cancers of the esophagus account for 5% of all deaths (or 407,000 deaths) from cancer annually.2 Moreover, as the majority of patients with esophageal cancer are diagnosed at an advanced stage, curative treatment is limited and

Predictive Value of LINC01133 for Unfavorable Prognosis was Impacted by Alcohol in Esophageal Squamous Cell Carcinoma

“…In our study, drinking status, and not smoking status, was significant in OS and PFS by a univariate analysis, but the independent effect of drinking status on the risk of ESCC was not substantiated by a multivariate Cox proportional analysis, consistent with previous results [34,35]. A potential explanation is that tobacco use impairs the predictive accuracy of drinking status in our cohort, in which only 6.04% of patients were pure drinkers.…”

Predictors of survival among patients diagnosed with adenocarcinoma of the esophagus and gastroesophageal junction

“…We found that current smokers had significantly increased risk of early death from GEJAC, independent of clinico-pathologic prognostic factors. Analogous studies have reported that smoking is an independent prognostic factor for upper digestive and oral cancers [27], and we have recently reported an adverse association with ESCC survival [15]. Assuming that the association with GEJAC cancer is real, it is possible that tobacco may indirectly influence survival for these cancers by suppressing the host defenses against cancer [28].…”

“…In a recent Australian study, we found that smoking and alcohol consumption were associated with poor survival for ESCC, independent of the effects of other prognostic factors [15]. Only two previous population-based studies have investigated whether lifestyle factors influence survival for EAC [12,16].…”

Alcohol Drinking and Second Primary Cancer Risk in Patients with Upper Aerodigestive Tract Cancers: A Systematic Review and Meta-analysis of Observational Studies

“…These observations illustrate the capacity of these risk factors to favor the development of cancers simultaneously or successively at various sites, and justify to reinforce prevention on such major nutritional risk factors. Alcohol consumption at index diagnosis of UADT cancer has been associated with significantly increased mortality and recurrence (41)(42)(43)(44)(45)(46). Moreover, quitting drinking after UADT cancer diagnosis has been shown to be associated with a better prognosis (44,47).…”