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Abstract

Background: Esophageal cancer (EC) is a major global health concern due to its high fatality rate. Although Thailand reports a relatively low incidence, the disease’s prevalence has increased over the past decade. This study aimed to evaluate survival time and identify factors associated with mortality among EC patients.

Methods: A hospital-based cohort study was conducted at the tertiary hospital in northeastern, Thailand, including 101 EC patients diagnosed between 2006 and 2015. Subjects were followed for six months. Clinical data were retrospectively collected from medical records and the Cancer Registry. Survival probability was estimated using Kaplan-Meier method, and Cox’s proportional hazards model was applied to identify mortality-associated factors.

Results: The median survival time was 4.2 months (95% confidence interval [CI]: 2.97–5.10). The mortality rate was 16.97% (95%CI: 13.10–21.63) per 100 person-months. It revealed that factors: diagnostic procedures, grading, radiotherapy, and surgical therapy were associated with mortality among subjects. Advanced diagnostic procedures increased mortality risk (adjusted hazard ratio [AHR] = 3.04, 95%CI: 1.46–6.33). Conversely, patients with poor or unknown EC differentiation (AHR = 0.33, 95%CI: 0.15–0.71; AHR = 0.11, 95%CI: 0.03–0.38, respectively) and those undergoing surgery or radiotherapy (AHR = 0.43, 95%CI: 0.21–0.87; AHR = 0.35, 95%CI: 0.16–0.78, respectively) had improved survival.

Conclusion: While advanced diagnostic procedure correlated with higher mortality, radiotherapy and surgery were linked to improved outcome. The unexpected association between poor tumor differentiation and reduced mortality warrants further investigation. Early detection and timely intervention remain crucial for improving prognosis in EC patients.

Keywords: Esophageal cancer, Mortality, Northeastern Thailand, Survival, Tertiary care

References

[1] Weinberg RA. How cancer arises. Sci Am 1996;275(3):62—70. https://doi.org/10.1038/scientificamerican0996-62.

[2] Popescu CR, Bertesteanu SV, Mirea D, Grigore R, lonescu D, Popescu B. The epidemiology of hypopharynx and cervical esophagus cancer. J Med Life 2010;3(4): 396—401. PMID: 21254737; PMCID: PMC3019060.

[3] Menezes MA, Sato RO, Schlottmann F, Herbella FAM. Esophageal anatomy. In: Schlottmann F, Molena D, Patti M, editors. Esophageal cancer. Cham: Springer; 2018. https://link.springer.com/chapter/10.1007/978-3-319-91830-3_1.

[4] Sunpaweravong S. Epidemiology and risk factors of esophageal cancer. Thai J Surg 2010;31(4):113—9. https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/227597.

[5] Rafiemanesh H, Maleki F, Mohammadian-Hafshejani A, Salemi M, Salehiniya H. The trend in histological changes and the incidence of esophagus cancer in Iran (2003-2008). Int J Prev Med 2016;7:31. https://doi.org/10.4103/2008-7802.175990.

[6] Yousefi M, Sharifi-Esfahani M, Pourgholam-Amiji N, Afshar M, Sadeghi-Gandomani H, Otroshi O, et al. Esophageal cancer in the world: incidence, mortality and risk factors. Biomed Res Ther 2018;5(7):2504—17. https://doi.org/10.15419/bmrat.v5i7.460.

[7] Klingelh€ ofer D, Zhu Y, Braun M, Brüggmann D, Sch€ offel N, Groneberg DA. A world map of esophagus cancer research: a critical accounting. J Transl Med 2019;17(1):150. https://doi.org/10.1186/s12967-019-1902-7.

[8] Pakzad R, Mohammadian-Hafshejani A, Khosravi B, Soltani S, Pakzad I, Mohammadian M, et al. The incidence and mortality of esophageal cancer and their relationship to development in Asia. Ann Transl Med 2016;4(2):29. https://doi.org/10.3978/j.issn.2305-5839.2016.01.11.

[9] Chanvitan A, Geater AF, Chongsuvivatwong V, Ubolcholket S. Risk factors for squamous cell carcinoma of the esophagus in Southern Thailand. In: Nabeya Ki, Hanaoka T, Nogami H, editors. Recent advances in diseases of the esophagus. Tokyo: Springer; 1993. https://link.springer.com/chapter/10.1007/978-4-431-68246-2_61.

[10] Chobarporn T, Boonyatikarn S, Tharavej C. Characteristics and longterm outcome of adenocarcinoma of the esophagogastric junction: a 23-year experience at a tertiary hospital in Thailand. J Med Assoc Thai 2024;107(9):668—77. http://www.jmatonline.com/view.php?id=122.

[11] Burassakarn A, Pientong C, Tongchai P, Wongjampa W, Poosari A, Udomsin A, et al. Epidemiological evidence and association of human papillomavirus with esophageal cancer in northeastern Thailand: a case-control study. Front Microbiol 2023;14:1146322. https://doi.org/10.3389/fmicb. 2023.1146322.

[12] Methasate A, Trakarnsanga A, Akaraviputh T, Chinsawangwathanakol V, Lohsiriwat D. Radical esophagectomy for esophageal cancer: results in Thai patients. J Med Assoc Thai 2010;93(11):1256—61. PMID: 21114203.

[13] Swangsri J, Tawantanakorn T, Parakonthun T, Methasate A. Surgical outcome of three-field lymph node dissection for esophageal cancer: first report in Thailand. J Med Assoc Thai 2020;103(5):91—5. http://www.jmatonline.com/view.php?id=4383.

[14] Wonglhow J, Wetwittayakhlang P, Sunpaweravong P, Sathitruangsak C, Dechaphunkul A. Comparative analysis of concurrent chemoradiotherapy versus chemotherapy alone as first-line palliative treatments for advanced esophageal squamous cell carcinoma. J Clin Med 2024; 13(21):6353. https://doi.org/10.3390/jcm13216353.

[15] Wonglhow J, Wetwittayakhlang P, Sunpaweravong P, Sathitruangsak C, Dechaphunkul A. Comparing the efficacy of carboplatin plus 5-fluorouracil, cisplatin plus 5-fluorouracil, and best supportive care for advanced esophageal squamous cell carcinoma: a propensity score analysis from a tertiary hospital in Southern Thailand. J Clin Med 2024; 13(6):1735. https://doi.org/10.3390/jcm13061735.

[16] Nun-Anan P, Vilaichone RK. Late stage and grave prognosis of esophageal cancer in Thailand. Asian Pac J Cancer Prev 2015;16(5):1747—9. https://doi.org/10.7314/apjcp.2015.16.5.1747.

[17] Hirunwatthanakul P, Sriplung H, Geater A. Radium- contaminated water: a risk factor for cancer of the upper digestive tract. Asian Pac J Cancer Prev 2006;7(2):295—8. PMID: 16839204.

[18] World Health Organization. International classification of diseases for oncology (ICD-O)-3rd Edition, 1st Revision. Geneva, Switzerland: World Health Organization; 2020.

[19] Ayoade OF, Canavan ME, De Santis WP, Zhan PL, Boffa DJ. Surgical and endoscopic management of clinical T1b esophageal cancer. J Thorac Cardiovasc Surg 2025;169(1): 279—288.e5. https://doi.org/10.1016/j.jtcvs.2024.06.011.

[20] Wei MX, Song X, Zhao XK, Han WL, Bao Q, Han XN, et al. Clinicopathological characteristics and postoperative prognosis of patients with nuclear pedigree of esophageal squamous cell carcinoma. Front Oncol 2023;13:1190457. https://doi.org/10.3389/fonc.2023.1190457.

[21] Tustumi F, Kimura CM, Takeda FR, Uema RH, Salum RA, Ribeiro-Junior U, et al. Prognostic factors and survival analysis in esophageal carcinoma. Arq Bras Cir Dig 2016; 29(3):138—41. 0003. https://doi.org/10.1590/0102-672020160003

[22] Huang J, Koulaouzidis A, Marlicz W, Lok V, Chu C, Ngai CH, et al. Global burden, risk factors, and trends of esophageal cancer: an analysis of cancer registries from 48 countries. Cancers (Basel) 2021;13(1):141. https://doi.org/10.3390/cancers13010141.

[23] Eslick GD. Epidemiology of esophageal cancer. Gastroenterol Clin North Am 2009;38(1):17—25. https://doi.org/10.1016/j.gtc.2009.01.008.

[24] Tran PN, Taylor TH, Klempner SJ, Zell JA. The impact of gender, race, socioeconomic status, and treatment on outcomes in esophageal cancer: A population-based analysis. J Carcinog 2017;16:3. https://doi.org/10.4103/jcar.JCar_4_17.

[25] Shah MA, Altorki N, Patel P, Harrison S, Bass A, Abrams JA. Improving outcomes in patients with oesophageal cancer. Nat Rev Clin Oncol 2023 Jun;20(6):390—407. https://doi.org/10.1038/s41571-023-00757-y.

[26] Asombang AW, Chishinga N, Nkhoma A, Chipaila J, Nsokolo B, Manda-Mapalo M, et al. Systematic review and meta-analysis of esophageal cancer in Africa: Epidemiology, risk factors, management and outcomes. World J Gastroenterol 2019;25(31):4512—33. https://doi.org/10.3748/wjg.v25.i31.4512.

[27] Li S, Chen H, Man J, Zhang T, Yin X, He Q, et al. Changing trends in the disease burden of esophageal cancer in China from 1990 to 2017 and its predicted level in 25 years. Cancer Med 2021;10(5). https://doi.org/10.1002/cam4.3775.1889-9.

[28] Siewchaisakul P, Nanthanangkul S, Santong C, Suwanrungruang K, Vatanasapt P. Survival of cancer patients with co-morbid tuberculosis in Thailand. Asian Pac J Cancer Prev 2021;22(8):2701—8. https://doi.org/10.31557/APJCP.2021.22.8.2701.

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