Long-term trends in the clinical management and outcomes of patients with gastroesophageal cancer in Norway

Abstract

Background and purpose: Gastroesophageal cancers are highly prevalent internationally, with many patients diagnosed with metastatic disease, leading to challenging treatment and poor survival. This study uses real-world evidence from a population-level database to describe demographics, clinical characteristics, initial treatment patterns, and survival for patients with gastroesophageal cancer in Norway.

Material and methods: Individual patient data was sourced from the Cancer Registry of Norway for patients diagnosed with oesophageal squamous cell carcinoma (ESCC), oesophageal adenocarcinoma (EAC), gastroesophageal junction cancer (GEJC), and gastric cancer from 2001 to 2021, with follow-up from diagnosis to death or last follow-up. Treatment patterns were captured from 2010 to 2022, defined as curative or palliative based on surgery, chemotherapy, and radiotherapy.

Results and interpretation: The cohort included 14,334 Norwegian patients with gastroesophageal cancer; predominantly male, mean age 69-73 years, with a median follow-up of 9-11 months across cancer subtypes. Approximately 40% of patients received curative treatment, and multi-modality treatments increased for EAC, GEJC, and ESCC. Median survival ranged from 6 to 11 months for patients treated palliatively, and 17-95 months for those treated with curative intent. Interestingly, median survival was higher for patients with EAC and GEJC treated with neoadjuvant chemotherapy (86.1 and 75.1 months) versus neoadjuvant chemoradiotherapy (49.1 and 42.1 months), which was confirmed by a multivariate Cox regression model adjusted for age, sex, and disease stage. This study demonstrates that multimodal treatment strategies, consisting of chemotherapy and surgery, may be associated with improved survival outcomes for gastroesophageal cancers. Future studies are required to identify optimum treatment strategies for gastroesophageal cancer subtypes.

Figure 1

Cohort attrition. *Patients were excluded due to insufficient treatment pattern data available prior to 2010. EAC: oesophageal adenocarcinoma; ESCC: oesophageal squamous cell carcinoma; GC: gastric cancer; GEJC: gastroesophageal junction cancer; NET: neuroendocrine tumour.

Figure 2

Number of patients with each gastroesophageal cancer subtype by year of diagnosis, (A) and proportion of patients with oesophageal cancer (ESCC, EAC, and GEJC combined) (B) and gastric cancer (C) who received surgery as initial treatment by year of diagnosis. EAC: oesophageal adenocarcinoma; ESCC: oesophageal squamous cell carcinoma; GC: gastric cancer; GEJC: gastroesophageal junction cancer.

Figure 3

Three-year survival (95% CI) for patients with (A, D) ESCC, (B, E) combined EAC and GEJC, and (C, F) GC, for all patients and stratified by whether they received surgery. CI: confidence interval; EAC: oesophageal adenocarcinoma; ESCC: oesophageal squamous cell carcinoma; GEJC: gastroesophageal junction cancer; GC: gastric cancer; OS: overall survival.

Figure 4

Median OS for patients with (A) ESCC, (B) EAC, (C) GEJC, and (D) GC stratified by initial curative treatment strategy. CRT: chemoradiotherapy; EAC: oesophageal adenocarcinoma; ESCC: oesophageal squamous cell carcinoma; GEJC: gastroesophageal junction cancer; GC: gastric cancer; nCT: neoadjuvant chemotherapy; nCRT: neoadjuvant chemoradiotherapy; OS: overall survival.

Figure 5

Forest plot depicting the Cox regression multivariate analysis of overall survival in the combined patients with EAC or GEJC treated with curative intent. Note: The Forest plot illustrates the hazard ratio for mortality within the time period of the initial treatment patterns cohort 2010–2021. Reference variables were sex (male), cancer stage (localised), and curative treatment (neoadjuvant chemotherapy). EAC: oesophageal adenocarcinoma, GEJC: gastroesophageal junction cancer.