A geographic area with better outcome of esophageal carcinoma: is there an effect of ethnicity and etiologic factors?

Objectives: Although Iran, and especially the northeast of the country, is known as one of the areas in the world where esophageal cancer is most prevalent, there is no information on the survival rate of patients affected with this disease in this region. To address this issue, we conducted a study comprehensive enough to provide as accurate an estimate as possible. Any finding related to survival of patients in this area may be considered representative of Iran.

Methods: Esophageal cancer patients who were consecutively referred to the oncology centers of Omid and Imam Reza Hospitals from July 1997 to March 2004 were recruited for the study. Data collection included the demographical and clinical characteristics of patients in addition to treatment details. The median survival and overall survival rates, as well as the median event-free survival and event-free survival rates, were evaluated. Univariate and multivariate analyses were performed to detect any significant prognostic factors.

Results: 1,568 patients were eligible. The Kaplan-Meier analysis indicates that median survival is 38 months (95% CI, 26.6-49.3), 5-year survival is 42% (38.76-46.16%), median event-free survival is 21 months (95% CI, 18.2-23.8) and 5-year event-free survival is 29.9% (27.07-32.67%). The univariate analysis indicates that age, gender, tumor histology, tumor location, body mass index and disease stage are significant predictors of overall survival. However, in the multivariate analysis, disease stage is the best prognostic factor.

Conclusion: The prognosis of esophagus cancer in Iran is not as dismal as in other world regions. Our treatment outcome and survival rates are much higher than those reported especially in western countries.