Stage-dependent survival in esophageal cancer: a Danish nationwide cohort study

Esophageal cancer ranks among the top 10 most prevalent cancers worldwide, with Denmark experiencing over 800 new cases annually and a five-year survival rate as low as 10%-15%. Despite treatment advancements, prognostic accuracy remains challenging. This study uses the widely adopted Union for International Cancer Control staging system to map esophageal cancer survival across stages. Between January 2013 and December 2021, 7855 esophageal cancers were registered in the Danish Esophagogastric Cancer Group database, covering 99% of all Danish esophageal cancers. Patients were stratified by treatment approach and histological type and staged according to the Union for International Cancer Control tumor-node-metastasis classification. All-cause mortality from diagnosis served as the endpoint, with follow-up until September 12, 2023. Statistical analyses included Kaplan-Meier methods and Cox proportional hazards regression. Definitive chemoradiotherapy showed lower overall survival (OS) compared with surgical treatment (p < 0.001) yet significantly higher than palliative treatment (p < 0.001). Among patients receiving surgical treatment for squamous cell carcinoma (SCC), no significant differences in OS between stages were observed (p = 0.25). As expected, surgically treated patients had better OS than those receiving palliative care, with 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel-treated patients showing a significant survival benefit (p = 0.001). Notably, a highly selected subgroup with Stage IVb disease who underwent surgery demonstrated unexpectedly high OS. Our examination of one of the most elaborate databases yielded a detailed overview of esophageal cancer survival outcomes. By mapping survival stratified by tumour stage and treatment status based on Danish treatment protocols, we hope to aid clinical decision-making for more individualized treatment protocols.