Survival expressed in best-case, typical and worst-case scenarios for patients with nonmetastatic esophagogastric cancer: A population-based study.

Abstract

259 Background: In recent years new treatment options and the centralization of surgery have improved survival for patients with non-metastatic esophageal and gastric cancer. However, it is currently unknown which patients have mostly benefitted from these treatment advances. The aim of this study was to use population-based data to identify best-case, typical and worst-case scenarios in terms of survival time, and to assess if the survival of these scenarios have changed over time. Methods: Patients diagnosed between 2006-2019 with non-metastatic esophageal (including gastro-esophageal junction tumors) or gastric cancer were selected from the Netherlands Cancer Registry. Best-case, typical, and worst-case scenarios were calculated from the 20th (best-case scenario), 40th (upper-typical), 50th (median), 60th (lower-typical) and 80th (worst-case scenario) percentiles of the survival curves. Linear trend analysis was used to investigate the change in survival time for each scenario across diagnosis years. Results: We identified 23350 patients with non-metastatic esophageal cancer and 10150 patients with non-metastatic gastric cancer. Linear trend analyses across diagnosis years showed that for esophageal cancer patients, survival of all scenarios significantly increased over time: the best-case scenario increased from 55 to 112 months (p =.003); the upper typical increased from 18 to 33 months (p <.001); the median increased from 13 to 23 months (p <.001); the lower typical increased from 8 to 15 months (p <.001) and the worst-case scenario increased from 4 to 7 months (p <.001). For patients with gastric cancer, all scenarios also improved significantly: the best-case scenario increased from 73 to 99 months (p =.045); the upper-typical increased from 22 to 33 months (p <.001); the median increased from 14 to 18 months (p <.001); the lower-typical increased from 14 to 18 months (p <.001) and the worst-case scenario increased slightly from 2.9 months to 3.0 (p =.017). Conclusions: All patients with non-metastatic esophageal and gastric cancer have improved their survival over time.The largest survival advantage was among the best-case and upper-typical scenarios. Therefore, treatment advances over the last years have improved survival for all patients with non-metastatic esophagogastric cancer.