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. 2022 Mar;113(3):1038-1046.
doi: 10.1111/cas.15262. Epub 2022 Jan 25.

Treatment patterns and survival in advanced unresectable esophageal squamous cell cancer: A population-based study

Marieke Pape  1   2 , Pauline A J Vissers  1   3 , Judith de Vos-Geelen  4 , Maarten C C M Hulshof  5 , Suzanne S Gisbertz  6 , Paul M Jeene  5   7 , Hanneke W M van Laarhoven  2 , Rob H A Verhoeven  1   2
Affiliations

Treatment patterns and survival in advanced unresectable esophageal squamous cell cancer: A population-based study

Marieke Pape et al. Cancer Sci. 2022 Mar.

Abstract

Data on treatment and survival of patients with advanced unresectable esophageal squamous cell carcinoma (ESCC) from Western populations are limited. Here we describe treatment and survival in patients with advanced unresectable ESCC: patients with cT4b disease without metastases (cT4b), metastases limited to the supraclavicular lymph nodes (SCLNM) or distant metastatic ESCC at the population level. All patients with unresectable (cT4b) or synchronous metastatic ESCC at primary diagnosis (2015-2018) or patients with metachronous metastases after primary non-metastatic diagnosis in 2015-2016 were selected from the Netherlands Cancer Registry. Fifteen percent of patients had cT4b disease (n = 146), 12% SCLNM (n = 118) and 72% distant metastases (n = 681). Median overall survival (OS) time was 6.3, 11.2, and 4.4 months in patients with cT4b, SCLNM, and distant metastases, respectively (P < .001). Multivariable Cox regression showed that patients with cT4b (hazard ratio 1.44, 95% CI 1.04-1.99) and patients with distant metastases (hazard ratio 1.42, 95% CI 1.12-1.80) had a worse survival time compared with patients with SCLNM. Among patients who received chemoradiotherapy and/or underwent resection (primary tumor and/or metastases), median OS was 11.9, 16.1, and 14.0 months in patients with cT4b, SCLNM, and distant metastases, respectively (P = .76). Patients with SCLNM had a better survival time compared with patients with cT4b and patients with distant metastases. Survival of patients with advanced unresectable ESCC in clinical practice was poor, even in patients treated with curative intent.

Keywords: distant metastases; esophageal squamous cell carcinoma; palliative treatment; supraclavicular lymph node metastases; unresectable advanced disease.

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Conflict of interest statement

JdV has served as a consultant for Amgen, AstraZeneca, MSD, Pierre Fabre, and Servier, and has received institutional research funding from Servier. HvL reports grants from Roche, has served as a consultant for BMS, Celgene, Lilly, and Nordic and has received unrestricted research funding from Bayer, BMS, Celgene, Lilly, Merck Serono, MSD, Nordic, Philips, and Roche. RV reports grants from BMS and Roche. MP, PV, MH, SG, and PJ have no disclosures to declare.

Figures

FIGURE 1
FIGURE 1
Flowchart of patient selection
FIGURE 2
FIGURE 2
Word cloud of the 15 systemic treatment regimens that were administered. Font size of the word corresponds to the number of patients that received the regimen. CapOx, capecitabine and oxaliplatin; CarboPac, carboplatin and paclitaxel; ECC, epirubicin, cisplatin, and capecitabine; EOX, epirubicin, oxaliplatin, and capecitabine; FOLFOX, fluorouracil and oxaliplatin
FIGURE 3
FIGURE 3
Overall survival of patients with cT4b, SCLNM, or distant metastases after unresectable or metastatic diagnosis
FIGURE 4
FIGURE 4
Overall survival of patients with cT4b, SCLNM or distant metastases who received chemoradiotherapy and/or underwent resection after unresectable or metastatic diagnosis
FIGURE 5
FIGURE 5
Overall survival of patients with cT4b, SCLNM, or distant metastases who received best supportive care after unresectable or metastatic diagnosis
See this image and copyright information in PMC

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