Esophageal Cancer Mortality Research Articles

Minimally invasive Ivor-Lewis esophagectomy for esophageal cancer.

Background In this study, we present our minimally invasive Ivor-Lewis esophagectomy technique and survival rates of this technique. Methods Between September 2013 and December 2020, a total of 140 patients (56 males, 84 females; mean age: 55.5±10.3 years; range, 32 to 76 years) who underwent minimally invasive Ivor- Lewis esophagectomy for esophageal cancer were retrospectively analyzed. Preoperative patient data, oncological and surgical outcomes, pathological results, and complications were recorded. Results Primary diagnosis was esophageal cancer in all cases. Minimally invasive Ivor-Lewis esophagectomy was carried out in all of the cases included in the study. Neoadjuvant chemoradiotherapy was administrated in 97 (69.3%) of the cases. The mean duration of surgery was 261.7±30.6 (range, 195 to 330) min. The mean amount of intraoperative blood loss was 115.1±190.7 (range, 10 to 800) mL. In 60 (42.9%) of the cases, complications occurred in intraoperative and early-late postoperative periods. The anastomotic leak rate was 7.1% and the pulmonary complication rate was 22.1% in postoperative complications. The mean hospital stay length was 10.6±8.4 (range, 5-59) days and hospital mortality rate was 2.1%. The median follow-up duration was 37 (range, 2-74) months and the three- and five-year overall survival rates were 61.8% and 54.6%, respectively. Conclusion Minimally invasive Ivor-Lewis esophagectomy can be used safely with low mortality and long-time survival rates in esophageal cancer.

China guideline for the screening, early detection and early treatment of esophageal cancer (2022, Beijing)

Esophageal cancer (EC) is a major digestive tract malignancy in China, which seriously threatens the health of Chinese population. A large number of researches have demonstrated that screening and early detection are effective in reducing the incidence and mortality of EC. The development of the guideline for EC screening and early detection in line with epidemic characteristics of EC in China will greatly promote the homogeneity and standardization, and improve the effect of EC screening. This guideline was commissioned by the Bureau of Disease Control and Prevention of the National Health Commission. The National Cancer Center of China initiated and convened a working group comprising multidisciplinary experts. Following the World Health Organization Handbook for Guideline Development, this guideline combined the most up-to-date evidence of EC screening, China's national conditions, and practical experience in cancer screening. This guideline provided evidence-based recommendations with respect to the screening population, technology and procedure management, aiming to improve the effect of EC screening and provide scientific evidence for the EC prevention and control in China.

Statins and the risk of gastric, colorectal, and esophageal cancer incidence and mortality: a cohort study based on data from the Korean national health insurance claims database.

This study investigated the association between the use of statins, the incidence of gastric, colorectal, and esophageal cancers, and mortality between January 2005 and June 2013 in South Korea. We compared patients aged 45-70years statin users for at least 6months to non-statin users matched by age and sex, from 2004 to June 2013 using the National Health Insurance database. Main outcomes were gastric, colorectal, and esophageal cancer incidence and mortality. Cox proportional hazard regression was used to calculate the adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs) among overall cohort and matched cohort after propensity score matching with a 1:1 ratio. Out of 1,008,101 people, 20,473 incident cancers, 3938 cancer deaths occurred and 7669 incident cancer, 1438 cancer death in matched cohort. The aHRs for the association between the risk of cancers and statin use were 0.7 (95% CI 0.65-0.74) for gastric cancer, 0.73 (95% CI 0.69-0.78) for colorectal cancer, and 0.55 (95% CI 0.43-0.71) for esophageal cancer. There were associations between statin use and decreased gastric cancer mortality (HR 0.46, 95% CI 0.52-0.57), colorectal cancer mortality (HR 0.43, 95% CI 0.36-0.51), and esophageal cancer mortality (HR 0.41, 95% CI 0.27-0.50) in the overall cohort and this pattern was similar in the matched cohort. Statin use for at least 6months was significantly associated with a lower risk of stomach, colorectal, and esophageal cancer incidence as well as cancer mortality after a diagnosis.

Effectiveness evaluation of adjuvant concurrent chemoradiotherapy for patients with positron emission tomography-staged esophageal squamous cell carcinoma after complete resection: A population-based cohort study.

BackgroundThe role of adjuvant concurrent chemoradiotherapy (ACCRT) is unclear for patients with esophageal squamous cell carcinoma (ESCC) who receive esophagectomy with clean margins. We compared the survival of the ACCRT versus observation groups for these patients staged with positron emission tomography (PET) via a population‐based approach.MethodsEligible patients with locally advanced ESCC diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratios (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between the ACCRT and observation groups. We also evaluated overall survival (OS) in subgroups of either with or without lymph node metastases.ResultsOur primary analysis consisted of 105 patients in whom the covariates were well balanced after PS weighting. The HR for death when ACCRT was compared with observation was 0.58 (95% confidence interval 0.28–1.21, p = 0.15). The results were also not significantly different for IECM or in the subgroup analyses.ConclusionWe found that for patients with PET‐staged ESCC who received esophagectomy with clean margins, the survival was not statistically different between ACCRT and observation. Further studies (randomized or larger sample size) are needed to clarify this issue.

Association of Esophageal Cancer Mortality with Municipal Socioeconomic Deprivation Level in Japan, 2013-2017: An Ecological Study Using Nationwide Data.

This study aimed to show geographical differences in esophageal cancer mortality in Japan and reveal an association of esophageal cancer mortality with municipal socioeconomic deprivation level. Esophageal cancer mortality data in the Vital Statistics from 2013 to 2017 for each municipality and corresponding population data were analyzed. The deprivation level was derived from the municipal socioeconomic variables by principal component analysis. Municipalities were classified into five quintiles based on the deprivation level, and an association between the level and esophageal cancer mortality was evaluated using a Bayesian spatial model. As a result of regression analysis, the relative risk of esophageal cancer mortality tended to become larger as the deprivation level increased irrespective of sex, and the relative risk of esophageal cancer mortality was significantly higher in quintile 5 (most deprived) than quintile 1 (least deprived) among men and women. These results suggest that the deprivation level increases the risk of esophageal cancer mortality in Japan.

Association between body mass index and oesophageal cancer mortality: a pooled analysis of prospective cohort studies with >800 000 individuals in the Asia Cohort Consortium.

The association between body mass index (BMI) and oesophageal cancer (OC) has been consistently negative among Asians, whereas different associations based on histological OC subtypes have been observed in Europeans and North Americans. We examined the association between BMI and OC mortality in the Asia Cohort Consortium. We performed a pooled analysis to evaluate the association between BMI and OC mortality among 842 630 Asians from 18 cohort studies. Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs. A wide J-shaped association between BMI and overall OC mortality was observed. The OC mortality risk was increased for underweight (BMI <18.5 kg/m2: HR = 2.20, 95% CI 1.80-2.70) and extreme obesity (BMI ≥35 kg/m2: HR = 4.38, 95% CI 2.25-8.52) relative to the reference BMI (23-25 kg/m2). This association pattern was confirmed by several alternative analyses based on OC incidence and meta-analysis. A similar wide J-shaped association was observed in oesophageal squamous cell carcinoma (OSCC). Smoking and alcohol synergistically increased the OC mortality risk in underweight participants (HR = 6.96, 95% CI 4.54-10.67) relative to that in reference BMI participants not exposed to smoking and alcohol. Extreme obesity and being underweight were associated with an OC mortality risk among Asians. OC mortality and BMI formed a wide J-shaped association mirrored by OSCC mortality. Although the effect of BMI on OSCC and oesophageal adenocarcinoma mortality can be different in Asians, further research based on a large case-control study is recommended.

Changing trend of incidence and mortality of esophageal cancer during 2010-2016 in Henan Province, China

Objective: To estimate the incidence and mortality of esophageal cancer in 2016 and their changing trend during 2010-2016 according to the cancer registration data in Henan province. Methods: The data quality including completeness, validity, and reliability of local registries which submitted the cancer registration data of 2016 were assessed according to the criteria of Guideline on Cancer Registration in China and IARC/IACR. Esophageal cancer cases (ICD10: C15) were extracted from the database, and the incidence and mortality stratified by gender, age, and areas (urban/rural) were calculated, the incidence and mortality of provincial cancer were estimated combined with provincial population data. China's 2000 census population and Segi's population were used to calculate the age-standardized rate. Joinpoint model was used to estimate the changing trend of age standardized incidence and mortality along with the calendar year. Results: Approximately 40.10 thousand new esophageal cancer cases were diagnosed in Henan in 2016, accounting for 13.46% of all new cancer cases, and it ranked the third among cancer of all sites. The crude incidence of esophageal cancer was 37.21/100 000 with an age-standardized incidence rate by China standard population (ASIRC) of 26.74/100 000 and an age-standardized incidence rate by world standard population (ASIRW) of 27.12/100 000. The incidence of esophageal cancer in males was higher than that in females, with the ASIRC of 34.53/100 000 and 19.19/100 000, respectively. It was higher in rural areas than that in urban areas, with the ASIRC of 28.13/100 000 and 20.90/100 000, respectively. About 29.30 thousand deaths of esophageal cancer in Henan in 2016, accounting for 15.61% of all cancer deaths in Henan, which ranked the third among cancer of all sites. The crude mortality rate was 27.14/100 000 with an age-standardized mortality rate by China standard population (ASMRC) of 18.74/100 000 and an age-standardized mortality rate by world standard population (ASMRW) of 18.78/100 000. The mortality in males was higher than that in females, with the ASMRC of 24.78/100 000 and 13.12/100 000, respectively. It was also higher in rural areas than that in urban areas, with the ASMRC of 19.48/100 000 and 15.73/100 000, respectively. The ASIRC and ASMRC were declining with annual percent change (APC) of 3.12% (APC=-3.12%; 95%CI: -5.30%, -0.90%; P=0.015) and 2.47% (APC=-2.47%; 95%CI: -4.70%, -0.20%; P=0.039) during 2010-2016. However, the significant declining trend was only observed in rural areas in Henan, and the changing trend was same between males and females. Conclusions: The incidence and mortality of esophageal cancer are declining since 2010, however, the disease burden remains large in Henan. Therefore, comprehensive prevention and control efforts should be strengthened according to its epidemic characteristics and risk factors.

Mortality Risk factors and SOX2 and mTOR expression in Patients with Esophageal Cancer.

Causes of mortality in EC patients are not confined to cancer-specific mortality but include various protein expressions of SOX2 and mTOR in Esophageal Cancer patients and their correlation with the clinical stage. Data about the risk factors and involvement of cancer-specific protein are still lacking. This study aimed to define the risk factors and association of SOX2 and mTOR expression in mortality in patients with EC. We conducted a retrospective cohort study to assess the risk factors for cancer-specific mortality and cardiovascular mortality in patients with esophageal cancer (EC). The expression rates of SOX2, as well as MTO, were checked in patients. The multivariate analysis revealed a high-risk EC mortality with age ≥ 65 years, black race, grade, stage, and sequence of treatment; radiation after surgery; radiation before and after surgery; Surgery both before and after radiation. While the cardiovascular mortality increased with age ≥ 65 years, adenocarcinoma type, grade, stage, and sequence of treatment. The expression rates of SOX2, as well as mTOR, were 75.5 percent and 86.8 percent in Esophageal Cancer, while were 10.7 percent and 7.5 percent in osteochondroma, respectively, which was statistically significant (P<0.05). Risk factors for cancer-specific mortality and cardiovascular mortality in EC patients include older age at diagnosis, male sex, non-married status, grade III of the tumor, the regional or distant spread of the tumor, no cancer-directed therapy. The expression levels of SOX2, mTOR, and the total survival time were related to the different stages. It shows an upward trend for the expression levels of mTOR and SOX2 in Esophageal Cancer tissues. The expression levels of SOX2 and mTOR are related to the clinical stage, metastasis, and prognosis.

Trends in Incidence and Mortality of Esophageal Cancer in Huai'an District, a High-Risk Area in Northern Jiangsu Province, China.

PurposeThis study aimed to provide a clear comparable figure of the trends in incidence and mortality rates of esophageal cancer (EC) in Huai’an District, Huai’an City, Jiangsu Province, China, a high-risk area for EC.MethodsThe data for age- and sex-specific incidence rates between 1998 and 2016, the mortality rates in 1990-2016 and the number of EC patients were obtained from Huai’an District Cancer Registry. Crude rates, Age-standardized rates (ASRs) by world standard population and truncated age-standardized rates of EC incidence and mortality were calculated. The joinpoint regression analysis was used to calculate the annual percent changes (APC), average annual percent changes (AAPC), and their 95% confidence intervals (CIs).ResultsOverall, 20,892 new EC cases and 20,806 EC deaths were registered in Huai’an District. ASR of EC incidence from 1998 to 2016 and mortality from 1990 to 2016 were 73.32/100,000 and 60.03/100,000, respectively. The ASR illustrated that the incidence of EC had significant downward trends in total, male and female (AAPC = −4.65, −4.90, and −5.51, respectively, p <.01). The age-specific incidence and mortality rates of EC increased dramatically in people over the age of 40, and peaked in people between the ages 70-74. In the subdivisions of Huai’an District, geographical diversities in the crude incidence and mortality rates of EC were found.ConclusionIn summary, the incidence and mortality rates of EC showed downward trends in Huai’an District. However, the burden of EC still remained serious in this high-risk area. Cost-effective methods of intervention and health education should be enhanced for improving EC prevention.

Comparison of Secular Trends in Esophageal Cancer Mortality in China and Japan During 1990-2019: An Age-Period-Cohort Analysis

Comparison of Secular Trends in Esophageal Cancer Mortality in China and Japan During 1990-2019: An Age-Period-Cohort Analysis

Progress in risk factors and potential biomarkers of esophageal squamous cell carcinoma

Esophageal cancer is the main malignant cancer in China. In 2015, the incidence and mortality of esophageal cancer were 17.87 per 100 000 and 13.68 per 100 000, respectively, ranking 6th and 4th in the incidence and death. Esophageal squamous cell carcinoma (ESCC) is the main pathological type of esophageal cancer, accounting for 86.3% of new cases. ESCC's pathogenesis is still not clear and its related risk factors remain to be explored. There are no detection biomarkers that can be widely applied in the whole country nowadays. In order to provide a scientific basis for exploring the pathogenesis of ESCC and improve screening technology, this paper summarizes the research status of various risk factors and potential biomarkers of ESCC.

Trends of Esophageal Cancer Incidence and Mortality and Its Influencing Factors in China

PurposeTo explore the esophageal cancer (EC) incidence and mortality trends and risk factors in China during 2005–2015.Materials and MethodsThe data were stratified by area (urban, rural), gender (male, female), and age groups (0 ~, 5 ~, …, 85 ~). The age-standardized incidence rate (ASIR) and mortality rate (ASMR), age-specific incidence and mortality were calculated to describe the trends, which were analyzed by Joinpoint software, negative binomial regression model, and age-period-cohort model.ResultsTrends in EC ASIR decreased markedly during 2010–2015 (APC=−6.14%, P<0.05), and the average annual percent change (AAPC) value was −8.07% (95% confidence interval (CI): −9.98~−6.12) for rural areas during 2005–2015. The ASMR was on a fast-downward trend after 2011 (APC=−6.67%, P<0.05), with AAPC values of −1.34% (95% CI: −2.56~−0.19) for males, −3.39% (95% CI: −5.65, −1.07) for females, and −9.67% (95% CI: −10.56~−8.77) for rural areas during 2005–2015. The age-specific incidence and mortality increased with age. The risk of EC for males was 3.1675 times higher than females (P<0.001), and for urban areas, it was 0.58 times larger than rural (P<0.001). The age and period effects presented an increasing trend, with a decreasing trend for the cohort effects in incidence and mortality risk. Later birth cohorts presented lower risks than previous birth cohorts.ConclusionASIR and ASMR in China are higher in males than females, and higher in rural than urban areas, which have decreased during 2005–2015, especially in rural areas. The incidence increased with age up to the peak age group of 75. Area, gender, and age were independent risk factors for EC incidence.

State of the Russian Oncology Service: esophageal cancer. Population-based study at the federal district level. Part I. Morbidity and mortality rates, accuracy index, annual mortality

Malignant neoplasms (MNO) of esophagus is the localization with a high mortality rate. Years of searching for effective treatment in Russia have resulted in modest success. The median survival rate of patients is expressed in months, 70% of patients die in the first year of dispensary registration, the levels of one-year mortality rates for men and women practically do not differ.&#x0D; The esophageal cancer (EC) morbidity and mortality rates have slightly decreased in 20002018 in Russia and has declined only among the male population of the Northwestern Federal District.&#x0D; To study the trends in the morbidity and mortality rates in the population of Russia and the Northwestern Federal District of the Russian Federation. Qualitative analytical indicators, such as the accuracy index and the year-to-year mortality patterns in esophageal cancer patients, will be further considered.&#x0D; The highest standardized EC morbidity rates of the population were found in Zimbabwe (Harare, Africans) 15.5 0/0000, Japan (Miyage) 14.3 0/0000 and the Arkhangelsk region of Russia 12.8 0/0000. In 2000-2019 the level of standardized morbidity rates of the Russian population with EC has decreased from 3.44 to 3.19 0/0000 or 7.3% (both sexes), mortality rates from 3.32 to 2.66 0/0000, or 19.9%. A decrease in the morbidity and mortality rates from EC occurred in the Northwestern Federal District of the Russian Federation, only among the male population.&#x0D; Annual EC mortality rate mainly occurs according to the classical model. The highest level is determined in the first year of follow-up (72-74%); by the end of the decade, only 4.1% of patients remain from those initially recorded.&#x0D; The accuracy index has decreased in Russia and in the Northwestern Federal District of the Russian Federation, respectively, to 0.84 and 0.86 (both sexes) but has remained above the critical mark of 0.7 for localizations with a high mortality rate.

S1416 Medicaid Expansion Is Associated with Decreased Gastric Cancer Incidence

Introduction: Individuals in Medicaid expanded states have increased access to treatment for medical conditions and other health care resources, including preventive healthcare. Esophageal and gastric cancer are associated with several modifiable risk factors (i.e. smoking, drinking, obesity, Helicobacter pylori infection). The impact of Medicaid expansion on gastric and esophageal cancer incidence and mortality remains uninvestigated. Methods: We evaluated the association between Medicaid expansion and gastric and esophageal cancer incidence and mortality in adults aged 25-64. This study employed an observational design using a difference-in-differences method with state level data from 31 states (given the availability of complete data), from 2010 – 2017. Annual, age-adjusted gastric and esophageal incidence and mortality rates, from the CDC Wonder Database, were analyzed and were accounted for by ICD-O-3 and ICD-10, respectively. Rates were adjusted for gender, race, poverty, median household income, unemployment, insurance, smoking, alcohol consumption, diabetes mellitus, obesity, and number of physicians per 100,000 population. Results: In expansion states, median (IQR) gastric cancer incidence was unchanged: from 4.6 (4.2-5.2) to 4.6 (4.1-5.4) per 100,000 population from the pre-expansion to post-expansion period. There was an increase in median (IQR) gastric cancer incidence among non-expansion states, from 4.6 (4.2-5.0) to 4.8 (4.3-5.1) per 100,000 from pre- to post-expansion. There was no considerable change in gastric cancer mortality and esophageal cancer incidence and mortality pre- and post- expansion. Adjusted analyses demonstrate that expansion states had significantly fewer new cases of gastric cancer: -1.6 (95% CI: 0.2-3.5; P = .08) per 1,000,000 persons per year. No significant association was seen between Medicaid expansion and gastric cancer mortality (0.46 [95% CI: -0.08-0.17; P = .46]) and esophageal cancer incidence (0.8 [95% CI: -0.08- 0.24; P = .33]) and mortality (1.0 [95% CI: -0.06-0.26; P = 0.21]) in multivariable analyses. Annual adjusted medians for gastric and esophageal cancer mortality and incidence are shown in Figure 1. Conclusion: States that adopted Medicaid expansion saw a decrease in gastric cancer incidence among adults aged 25-64 when compared to states that did not expand Medicaid. Though several factors may influence gastric cancer incidence, this association is important to consider during health policy negotiations.Figure 1.: Annual distribution of age-adjusted gastric and esophageal cancer incidence and mortality rates pre- and post- Medicaid expansion.Table 1.: Comparison of sociodemographic and clinical characteristics of Expansion Vs Non-Expansion States based on 2010 data.

S427 Predictors for Lymph Node Metastasis and Survival of Patients With T1b Esophageal Adenocarcinoma Treated With Surgery and Endoscopic Therapy: An Analysis of Surveillance, Epidemiology, and End Results Database

Introduction: There have been a few population-based studies to compare the long-term outcomes of patients those received surgery versus with endotherapy (ET) for T1b esophageal adenocarcinoma (EAC). In this study, we aimed to determine the risk factors of lymph node metastasis (LNM) and evaluate the long-term survival of patients with T1b EAC who underwent ET or surgery. Methods: We used the Surveillance Epidemiology and End Result database to identify patients with T1b histologically confirmed EAC diagnosed between 2004-2018. Patients were grouped based on whether they received ET (n=185) or surgery (n=935). Prevalence of LNM at initial diagnosis was analyzed. Multivariate logistic regression was performed to identify factors associated with LNM and endoscopic therapy. A Cox proportional hazards model was performed to examine the association of treatment options and survival after controlling for potential confounders. Results: Overall, 16% of cases had LNM at the time of diagnosis. The risk factors for LNM included lesion size ≥20 mm (OR 1.7, 95%CI 1.2-2.4) and poor tumor differentiation (OR 1.6, 95%CI 1.2-2.3). The use of ET increased progressively, from 0.8% in 2008 to 1.6% in 2018. ET was more commonly performed in patients with age >65 yr (OR 2.7, 95%CI 1.5-4.6), tumor size ≤20mm (OR 2.1, 95%CI 1.3-3.7), recent year of diagnosis (2008-2018 vs 2004-2007; OR 3.1, 95%CI 1.7-5.7) and those without LNM. Three-year overall survival was higher in surgery group than in the ET group (65.4% vs 54.4%, p = 0.04). Of 946 patients with T1bN0M0 EAC, 177 underwent ET and 769 had radical surgery. After adjusting for patient and tumor specific factors, patients with T1bN0M0 EAC treated by ET had a worse overall survival outcome (HR 1.4, 95% CI 1.06-1.97, P=0.01) compared to those received surgery. ET and surgery resulted in statistically equivalent in esophageal cancer mortality [HR 0.98, 95%CI 0.62-1.56, P=0.96]. Conclusion: In T1b EAC, tumor size ≥20mm and poor differentiation are the significant risk factors for LNM. Cancer specific survival in patients with T1bN0M0 EAC treated with ET appears to be similar to those treated with surgery. We found that patients who have significant coexisting conditions such as older age, are less likely to undergo surgery, as reflected in our study that older patients were more likely to have ET, which could partly explain higher overall mortality in ET group.Figure 1.: A: In a multivariate Cox proportional hazards model, adjusted for clinical and tumor-related factors, ET was associated with increased cumulative hazard (HR 1.4, 95% CI 1.06-1.97) compared to surgery. B: No difference was noted in cancer specific survival between the treatment groups when adjusted for age, sex, race, tumor size, tumor differentiation, and year of diagnosis.

Surveillance of the Incidence and Mortality of Oral and Pharyngeal, Esophageal, and Lung Cancer in Nevada: Potential Implications of the Nevada Indoor Clean Air Act.

Reviews of national and state-specific cancer registries have revealed differences in rates of oral, esophageal, and lung cancer incidence and mortality that have implications for public health research and policy. Many significant associations between these types of cancers and major risk factors, such as cigarette usage, may be influenced by public health policy such as smoking restrictions and bans—including the Nevada Clean Indoor Air Act (NCIAA) of 2006 (and subsequent modification in 2011). Although evaluation of general and regional advances in public policy have been previously evaluated, no recent studies have focused specifically on the changes to the epidemiology of oral and pharyngeal, esophageal, and lung cancer incidence and mortality in Nevada. Methods: Cancer incidence and mortality rate data were obtained from the National Cancer Institute (NCI) Division of Cancer Control and Population Sciences (DCCPS) Surveillance, Epidemiology and End Results (SEER) program. Most recently available rate changes in cancer incidence and mortality for Nevada included the years 2012–2016 and are age-adjusted to the year 2000 standard US population. This analysis revealed that the overall rates of incidence and mortality from these types of cancer in Nevada differs from that observed in the overall US population. For example, although the incidence rate of oral cancer is decreasing in the US overall (0.9%), it is stable in Nevada (0.0%). However, the incidence and mortality rates from esophageal cancer are also decreasing in the US (−1.1%, −1.2%, respectively), and are declining more rapidly in Nevada (−1.5%, −1.9%, respectively). Similarly, the incidence and mortality rates from lung are cancer are declining in the US (−2.5%, −2.4%, respectively) and are also declining more rapidly in Nevada (−3.2%, −3.1%, respectively). Analysis of previous epidemiologic data from Nevada (1999–2003) revealed the highest annual percent change (APC) in oral cancer incidence in the US was observed in Nevada (+4.6%), which corresponded with the highest APC in oral cancer mortality (+4.6%). Subsequent studies regarding reduced rates of cigarette use due to smoking restrictions and bans have suggested that follow up studies may reveal changes in the incidence and mortality rates of oral and other related cancers. This study analysis revealed that oral cancer incidence rates are no longer increasing in Nevada and that mortality rates have started to decline, although not as rapidly as the overall national rates. However, rapid decreases in both the incidence and mortality from esophageal and lung cancer were observed in Nevada, which strongly suggest the corresponding changes in oral cancer may be part of a larger epidemiologic shift resulting from improved public health policies that include indoor smoking restrictions and bans.

Epidemiological Pattern of Esophageal Cancer based on the Database Analysis of National Cancer Registry of Ukraine

Background. Esophageal cancer remains a major medical challenge since it belongs to the most aggressive malignant neoplasms, usually diagnosed at a late stage of the disease.&#x0D; Purpose – Studying the general patterns of time course of esophageal cancer epidemiological status in terms of morbidity and mortality among the adult population of Ukraine within the period from 2014 to 2019.&#x0D; Materials and Methods. General and standardized morbidity and mortality rates resulting from esophageal cancer from 2014 to 2019 throughout Ukraine and in terms of administrative territories per 100 thousand adult population have been researched along with calculating the growth rate. The study was carried out based on the data of National Cancer Registry of Ukraine.&#x0D; Statistical processing of the obtained data was performed by means of generally accepted statistical methods.&#x0D; Results and discussion. The all-Ukrainian incidence of esophageal cancer averaged 4.5 per 100 thousand population. Zhytomyr, Sumy and Chernihiv regions can be considered as the regions with the highest incidence of esophageal cancer. The lowest number of esophageal cancer cases was found in Chernivtsi and Odesa regions of Ukraine.&#x0D; Esophageal cancer mortality rates ranged slightly from 3.3 to 3.6 per 100 thousand population, but it reduced by 8.3% within six years. Monitoring changes of esophageal cancer mortality rate over time, in 2014 and 2019 in Ivano-Frankivsk, Mykolaiv and Rivne regions and in Kyiv it increased by more than 20%. A 30% reduction in mortality was observed in Kirovohrad, Odesa, Kharkiv and Zhytomyr regions. In 2019, Odessa and Kirovograd could be considered the regions with a low mortality rate showing 2.1 per 100 thousand population. In 2018, 88% of esophageal cancer cases were diagnosed in men and only 12% in women. The vast majority of cancer patients were aged 50 to 80 years. Mortality from esophageal cancer was significantly higher in men (91.2%) compared to women.&#x0D; Conclusions. The consistency of morbidity and mortality levels of esophageal cancer among the population of Ukraine during 2014-2019 has been established with insignificant regional disparities.

PCN46 Economic Evaluation of Esophageal Cancer Screening Among Patients with Oral Cavity Cancer in Taiwan

Oral and esophageal cancer are the fourth and fifth leading causes of cancer deaths in Taiwan. Despite a good prognosis in oral cavity cancer (OCC), the mortality of the second primary esophageal cancer among patients with OCC has been confirmed. Moreover, the effect of esophageal cancer screening through endoscope inspection among patients with OCC is still unclear. This study aims to examine the cost-effectiveness of endoscope-based screening for esophageal cancer (EC) among over 30-year-old patients with different stages of OCC in Taiwan.

Optimal radiotherapy dose in cervical esophageal squamous cell carcinoma patients treated with definitive concurrent chemoradiotherapy: A population based study

BackgroundThe optimal radiotherapy dose for locally advanced cervical esophageal squamous cell carcinoma (C‐ESqCC) treated with definitive concurrent chemoradiotherapy (dCCRT) is unclear. Here, we aimed to compare the survival of those treated with high dose versus standard dose via a population based approach.MethodsEligible C‐ESqCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between high (60–70 Gy) and standard dose (50–50.4 Gy). We also evaluated the outcome in supplementary analyses via alternative approaches.ResultsOur primary analysis consisted of 141 patients in whom covariates were well balanced after PS weighting. The HR of death when high dose was compared with standard dose was 0.65 (95% confidence interval [CI]: 0.4–1.03, p = 0.07). The HR of IECM was 0.74 (p = 0.45). The HR of OS remained similarly insignificant in supplementary analyses.ConclusionsWe observed a trend in favor of high radiotherapy dose versus standard dose for C‐ESqCC treated with dCCRT in this population‐based nonrandomized study. Further studies are needed to confirm the findings of the study.

Income-inequality and rate of doctors per inhabitant and their influence on esophageal cancer mortality in Brazil.

e16089 Background: There are substantial disparities in esophageal cancer mortality across different social groups, including sex, race/ethnicity, geographical location and socio-economic status. Methods: This is an ecological study with secondary data from 2016 to 2018 that evaluated the effects of income-inequality and number of doctors per inhabitant on esophageal cancer mortality in Brazil and its Federative Units. The amount of deaths and the overall number of doctors were obtained from the Department of Informatics of the Unified Health System. Mortality was estimated per 100,000 individuals and age-standardized through the World Health Organization’s population, whereas the rate of doctor per inhabitant was calculated per 1,000 inhabitants. Income-Inequality was measured by the Gini index, obtained from the United Nations Development Programme. Linear regression was performed by the stepwise backward method. Results: Sex, Gini index values and oncology surgeons were all related to lower mortality rates (p &lt; 0.05), whereas clinical oncologists and general surgeons were both associated with higher mortality (p &lt; 0.05). Conclusions: Esophageal cancer mortality rates were influenced by both the type and amount of doctors per inhabitant of any given administrative region in Brazil, however there was no association found with regards to income inequality.[Table: see text]