Management and prognosis of esophageal cancers: has progress been made?

The aim of this study was to investigate time trends in treatment and prognosis of esophageal cancer in a well-defined French population. Data was obtained from the Burgundy Cancer Registry (France) and three time periods were defined: 1976-90, 1991-96 and 1997-2002. A logistic regression was used to identify factors associated with an R0 resection. A multivariate survival analysis was performed using a Cox model. From 1976 to 2002, 2267 patients were included. The R0 resection rate slightly increased from 20.9% to 25.8% (P=0.019) then remained stable. Operative mortality decreased from 11.7% to 6.7% (NS). Age and subsite significantly influenced the rate of resection for cure whereas period had no effect. Chemotherapy alone was seldom used and radiotherapy alone dramatically dropped over time. Chemoradiation used as adjuvant treatment increased from 16.3% (1976-90) to 30.6% (1997-02) (P<0.001) and as sole treatment from 16.0% to 48.5% (P<0.001). The 3-year survival rates were respectively 10.1% and 9.7% (NS). Age and stage at diagnosis influenced the prognosis of esophageal cancer whereas time period and histology had no influence. This study claims that esophageal cancer remains a serious cancer problem and no improvement has been seen in the study population in France in its management over time.