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Comparative Study
. 2021 Nov 1;274(5):743-750.
doi: 10.1097/SLA.0000000000005127.

Presentation, Treatment, and Prognosis of Esophageal Carcinoma in a Nationwide Comparison of Sweden and the Netherlands

Marianne C Kalff  1 , Eivind Gottlieb-Vedi  2 , Rob H A Verhoeven  3   4 , Hanneke W M van Laarhoven  4 , Jesper Lagergren  2 , Suzanne S Gisbertz  1 , Sheraz R Markar  2   5 , Mark I van Berge Henegouwen  1
Affiliations
Comparative Study

Presentation, Treatment, and Prognosis of Esophageal Carcinoma in a Nationwide Comparison of Sweden and the Netherlands

Marianne C Kalff et al. Ann Surg. .

Abstract

Objective: This population-based study aimed to compare presentation, treatment allocation and survival of potentially curable esophageal cancer patients between Sweden and the Netherlands.

Summary of background data: Identification of inter-country differences in treatment allocation and survival may be used for targeted esophageal cancer care improvement.

Methods: Nationwide datasets were acquired from a Swedish cohort study and the Netherlands Cancer Registry. Patients with potentially curable (cT1-T4a/Tx, cN0/+, cM0/x) esophageal adenocarcinoma or squamous cell carcinoma (SCC) diagnosed in 2011-2015 were included. Multivariable logistic regression provided odds ratios (OR) for treatment allocation, and multivariable Cox model provided hazard ratios (HR) for overall survival, all with 95% confidence intervals (CI), adjusted for age, sex, year, tumor sub-location and stage.

Results: Among 1980 Swedish and 7829 Dutch esophageal cancer patients, Swedish patients were older (71 vs 69 years, P <0.001) and had higher cT-stage (cT3: 49% vs 46%, P <0.001). After adjustment for confounders, Swedish patients were less frequently allocated to curative treatment (adenocarcinoma: OR=0.31, 95%CI 0.26-0.36; SCC: OR=0.28, 95%CI 0.22-0.36). Overall survival was lower in Swedish patients (adenocarcinoma: HR=1.36, 95%CI 1.27-1.46; SCC: HR=1.38, 95%CI 1.24-1.53), also when allocated to curative treatment (adenocarcinoma: HR=1.12, 95%CI 1.01-1.24; SCC: HR=1.34, 95%CI 1.14-1.59).

Conclusion: Swedish patients with potentially curable esophageal cancer were less frequently allocated to curative treatment, and showed lower survival compared to Dutch patients. The less pronounced inter-country survival difference after curative treatment suggests that the overall survival difference could at least partly be due to relative undertreatment of Swedish patients. Shared curative treatment thresholds across Europe may help improve survival of esophageal cancer patients.

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Conflict of interest statement

Van Laarhoven has served as a consultant for BMS, Celgene, Lilly, Merck, Nordic, and Servier and has received unrestricted research funding from Bayer, BMS, Celgene, Lilly, Merck Serono, MSD, Nordic, Philips, Roche and Servier. Van Berge Henegouwen reports research grants from Olympus and Stryker, in addition to consulting fees from Medtronic, Mylan, Alesi Surgical and Johnson and Johnson. Verhoeven has received unrestricted research grants from BMS and Roche. The remaining authors have no conflict of interest to report. No funding was received for this study.

References

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Supplementary concepts