Annals of Surgical Oncology

, Volume 20, Issue 9, pp 3023–3030 | Cite as

Outcome of Patients with Esophageal Cancer: A Nationwide Analysis

  • Miao-Fen Chen
  • Yao-Hsu Yang
  • Chia-Hsuan Lai
  • Pau-Chung Chen
  • Wen-Cheng Chen
Thoracic Oncology



Esophageal cancer is 1 of the 10 most common cancers and is a particular devastating form of cancer worldwide. More than 90 % patients with esophageal cancer in Taiwan have squamous cell carcinoma (SCC). In the present study, we assessed the factors affecting survival of patients with esophageal cancer using data from Taiwan, a high-incidence area for esophageal SCC.


We performed a retrospective review of 12,482 patients who were newly diagnosed with esophageal cancer from 1998 to 2007. The data were obtained from the National Health Insurance Research Database in Taiwan. Study participants were followed-up until the end of 2008.


Of the 12,482 patients, 11,490 (92.1 %) were male with a median age of 60 years, and 992 (7.9 %) were female with a median age of 71 years at the time of diagnosis. The overall 1-, 2-, 5-, and 10-year survival rates after diagnosis were 40.3, 22.9, 12.8, and 7.6 %, respectively. Among parametric models for esophageal cancer prognosis, male sex, no curative treatment (surgery and/or radiotherapy), old age, and low socioeconomic status were significantly associated with shorter survival. Furthermore, curative treatment with surgery improved the survival of esophageal cancer patients more significantly compared with patients who undergo definite radiotherapy.


Our data indicated that age, sex, and curative treatment were significant predictors of lifetime survival in patients with esophageal cancer. The overall survival rates of patients with esophageal cancer are relatively low, while survival of patients who undergo surgery is improved significantly.


Esophageal Cancer Esophageal Squamous Cell Carcinoma Esophageal Cancer Patient Relative Excess Risk National Health Insurance Research Database 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Ward EM, Thun MJ, Hannan LM, Jemal A. Interpreting cancer trends. Ann N Y Acad Sci. 2006;1076:29–53.PubMedCrossRefGoogle Scholar
  2. 2.
    Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003;349:2241–52.PubMedCrossRefGoogle Scholar
  3. 3.
    Besharat S, Jabbari A, Semnani S, Keshtkar A, Marjani J. Inoperable esophageal cancer and outcome of palliative care. World J Gastroenterol. 2008;14:3725–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Brown LM, Hoover R, Silverman D, Baris D, Hayes R, Swanson GM, et al. Excess incidence of squamous cell esophageal cancer among US Black men: role of social class and other risk factors. Am J Epidemiol. 2001;153:114–22.PubMedCrossRefGoogle Scholar
  5. 5.
    Gao YT, McLaughlin JK, Blot WJ, Ji BT, Benichou J, Dai Q, et al. Risk factors for esophageal cancer in Shanghai, China. I. Role of cigarette smoking and alcohol drinking. Int J Cancer. 1994;58:192–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Wu M, Zhao JK, Zhang ZF, Han RQ, Yang J, Zhou JY, et al. Smoking and alcohol drinking increased the risk of esophageal cancer among Chinese men but not women in a high-risk population. Cancer Causes Control. 2011;22:649–57.PubMedCrossRefGoogle Scholar
  7. 7.
    Bollschweiler E, Wolfgarten E, Gutschow C, Holscher AH. Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer. 2001;92:549–55.PubMedCrossRefGoogle Scholar
  8. 8.
    Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006;24:2137–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29.PubMedCrossRefGoogle Scholar
  10. 10.
    Burmeister BH, Smithers BM, Gebski V, Fitzgerald L, Simes RJ, Devitt P, et al. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol. 2005;6:659–68.PubMedCrossRefGoogle Scholar
  11. 11.
    Bedenne L, Michel P, Bouche O, Milan C, Mariette C, Conroy T, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007;25:1160–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Siewert JR, Stein HJ, Feith M, Bruecher BL, Bartels H, Fink U. Histologic tumor type is an independent prognostic parameter in esophageal cancer: lessons from more than 1,000 consecutive resections at a single center in the Western world. Ann Surg. 2001;234:360–7; discussion 368–9.Google Scholar
  13. 13.
    Mariette C, Finzi L, Piessen G, Van Seuningen I, Triboulet JP. Esophageal carcinoma: prognostic differences between squamous cell carcinoma and adenocarcinoma. World J Surg. 2005;29:39–45.PubMedCrossRefGoogle Scholar
  14. 14.
    Rohatgi PR, Swisher SG, Correa AM, Wu TT, Liao Z, Komaki R, et al. Histologic subtypes as determinants of outcome in esophageal carcinoma patients with pathologic complete response after preoperative chemoradiotherapy. Cancer. 2006;106:552–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Devesa SS, Blot WJ, Fraumeni JF, Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer. 1998;83:2049–53.PubMedCrossRefGoogle Scholar
  16. 16.
    Lee CH, Wu DC, Lee JM, Wu IC, Goan YG, Kao EL, et al. Anatomical subsite discrepancy in relation to the impact of the consumption of alcohol, tobacco and betel quid on esophageal cancer. Int J Cancer. 2007;120:1755–62.PubMedCrossRefGoogle Scholar
  17. 17.
    Wu IC, Lu CY, Kuo FC, Tsai SM, Lee KW, Kuo WR, et al. Interaction between cigarette, alcohol and betel nut use on esophageal cancer risk in Taiwan. Eur J Clin Invest. 2006;36:236–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Lu CL, Lang HC, Luo JC, Liu CC, Lin HC, Chang FY, et al. Increasing trend of the incidence of esophageal squamous cell carcinoma, but not adenocarcinoma, in Taiwan. Cancer Causes Control. 2010;21:269–74.PubMedCrossRefGoogle Scholar
  19. 19.
    van Blankenstein M, Looman CW, Siersema PD, Kuipers EJ, Coebergh JW. Trends in the incidence of adenocarcinoma of the oesophagus and cardia in the Netherlands 1989–2003. Br J Cancer. 2007;96:1767–71.PubMedCrossRefGoogle Scholar
  20. 20.
    Guardino JM, Khandwala F, Lopez R, Wachsberger DM, Richter JE, Falk GW. Barrett’s esophagus at a tertiary care center: association of age on incidence and prevalence of dysplasia and adenocarcinoma. Am J Gastroenterol. 2006;101:2187–93.PubMedCrossRefGoogle Scholar
  21. 21.
    Gavin AT, Francisci S, Foschi R, Donnelly DW, Lemmens V, Brenner H, et al. Oesophageal cancer survival in Europe: A EUROCARE-4 study. Cancer Epidemiol. 2012;36:505–12.PubMedCrossRefGoogle Scholar
  22. 22.
    Wo JY, Hong TS, Kachnic LA. Impact of age and comorbidities on the treatment of gastrointestinal malignancies. Semin Radiat Oncol. 2012;22:311–20.PubMedCrossRefGoogle Scholar
  23. 23.
    Micheli A, Ciampichini R, Oberaigner W, Ciccolallo L, de Vries E, Izarzugaza I, et al. The advantage of women in cancer survival: an analysis of EUROCARE-4 data. Eur J Cancer. 2009;45:1017–27.PubMedCrossRefGoogle Scholar
  24. 24.
    Cooper JS, Pajak TF, Rubin P, Tupchong L, Brady LW, Leibel SA, et al. Second malignancies in patients who have head and neck cancer: incidence, effect on survival and implications based on the RTOG experience. Int J Radiat Oncol Biol Phys. 1989;17:449–56.PubMedCrossRefGoogle Scholar
  25. 25.
    Chen CY, Lai CH, Lee KD, Huang SH, Dai YM, Chen MC. Risk of second primary malignancies in women with cervical cancer: A population-based study in Taiwan over a 30-year period. Gynecol Oncol. 2012;127:625–30.PubMedCrossRefGoogle Scholar
  26. 26.
    Koppert LB, Janssen-Heijnen ML, Louwman MW, Lemmens VE, Wijnhoven BP, Tilanus HW, et al. Comparison of comorbidity prevalence in oesophageal and gastric carcinoma patients: a population-based study. Eur J Gastroenterol Hepatol. 2004;16:681–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Wang JB, Fan JH, Liang H, Li J, Xiao HJ, Wei WQ, et al. Attributable causes of esophageal cancer incidence and mortality in China. PLoS One. 2012;7:e42281.PubMedCrossRefGoogle Scholar
  28. 28.
    Stahl M. Is there any role for surgery in the multidisciplinary treatment of esophageal cancer? Ann Oncol. 2010;21(Suppl 7):vii283–5.Google Scholar
  29. 29.
    Herskovic A, Russell W, Liptay M, Fidler MJ, Al-Sarraf M. Esophageal carcinoma advances in treatment results for locally advanced disease: review. Ann Oncol. 2012;23:1095–103.PubMedCrossRefGoogle Scholar
  30. 30.
    Steyerberg EW, Neville BA, Koppert LB, Lemmens VE, Tilanus HW, Coebergh JW, et al. Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol. 2006;24:4277–84.PubMedCrossRefGoogle Scholar
  31. 31.
    Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349:2117–27.PubMedCrossRefGoogle Scholar
  32. 32.
    Okines AF, Cunningham D. Multimodality treatment for localized gastro-oesophageal cancer. Ann Oncol. 2010;21(Suppl 7):vii286–93.Google Scholar
  33. 33.
    Faiz Z, Lemmens VE, Siersema PD, Nieuwenhuijzen GA, Wouters MW, Rozema T, et al. Increased resection rates and survival among patients aged 75 years and older with esophageal cancer: a Dutch nationwide population-based study. World J Surg. 2012;36:2872–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Cijs TM, Verhoef C, Steyerberg EW, Koppert LB, Tran TC, Wijnhoven BP, et al. Outcome of esophagectomy for cancer in elderly patients. Ann Thorac Surg. 2010;90:900–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Pultrum BB, Bosch DJ, Nijsten MW, Rodgers MG, Groen H, Slaets JP, et al. Extended esophagectomy in elderly patients with esophageal cancer: minor effect of age alone in determining the postoperative course and survival. Ann Surg Oncol. 2010;17:1572–80.PubMedCrossRefGoogle Scholar
  36. 36.
    Janssen-Heijnen ML, Houterman S, Lemmens VE, Louwman MW, Maas HA, Coebergh JW. Prognostic impact of increasing age and co-morbidity in cancer patients: a population-based approach. Crit Rev Oncol Hematol. 2005;55:231–40.PubMedCrossRefGoogle Scholar
  37. 37.
    Ma JY, Wu Z, Wang Y, Zhao YF, Liu LX, Kou YL, et al. Clinicopathologic characteristics of esophagectomy for esophageal carcinoma in elderly patients. World J Gastroenterol. 2006;12:1296–9.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Miao-Fen Chen
    • 1
    • 2
  • Yao-Hsu Yang
    • 3
    • 4
  • Chia-Hsuan Lai
    • 1
  • Pau-Chung Chen
    • 4
    • 5
    • 6
  • Wen-Cheng Chen
    • 1
    • 2
  1. 1.Department of Radiation OncologyChang Gung Memorial HospitalChiayiTaiwan
  2. 2.Chang Gung University, College of MedicineTaoyuanTaiwan
  3. 3.Traditional Chinese MedicineChang Gung Memorial HospitalChiayiTaiwan
  4. 4.Institute of Occupational Medicine and Industrial HygieneNational Taiwan University College of Public HealthTaipeiTaiwan
  5. 5.Department of Public HealthNational Taiwan University College of Public HealthTaipeiTaiwan
  6. 6.Department of Environmental and Occupational MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan

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