Esophageal Cancer: An Updated Review

Michael DiSiena, MD; Alexander Perelman, DO; John Birk, MD; Houman Rezaizadeh, MD

Disclosures

South Med J. 2021;114(3):161-168. 

In This Article

Prognosis

Based on the Surveillance, Epidemiology, and End Result (SEER) program data collected 2007–2013, 5-year survival of EC was approximately 43% for localized disease, approximately 23% for regional spread, and just under 5% in those with distant metastases.[2,91] AC and SCC have similar survival rates. An analysis of the SEER data investigating whether survival differed between AC and SCC based on treatment found no difference in survival across any of the major treatment modalities for EC, suggesting that both histologies respond to treatment similarly.[92] EC is prone to early metastasis, given that the esophagus does not have a serosa and that lymphatics of the esophagus are in the lamina propria (lymphatics of the rest of the gastrointestinal tract are in the muscularis propria). As such, although T1a lesions overall have metastasis rates of 0 to nearly 10%, T1b lesions that invade into the deep submucosa have metastasis rates from 15% to 60%.[93–95]

Survival rates have improved in the United States since the 1970s, and this is likely attributable to the fact that the proportion of patients diagnosed as having early-stage EC has increased.[5,91] It is concerning that multiple studies note that there continues to be a disparity between the survival rates of minorities, including the SEER 2007–2013 database, which noted a 5-year survival for localized disease of 23% for Blacks versus 45% for Whites and regional disease is 17% for Blacks versus 24% for Whites.[2]

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