Subjective factors affecting prognosis of 469 patients with esophageal squamous cell carcinoma: a retrospective cohort study of endoscopic screening

Jun Nakamura; Noriaki Manabe; Tomoki Yamatsuji; Yoshinori Fujiwara; Takahisa Murao; Maki Ayaki; Minoru Fujita; Akiko Shiotani; Tomio Ueno; Yasumasa Monobe; Takashi Akiyama; Ken Haruma; Yoshio Naomoto; Jiro Hata

doi:10.1186/s12876-022-02399-3

Subjective factors affecting prognosis of 469 patients with esophageal squamous cell carcinoma: a retrospective cohort study of endoscopic screening

BMC Gastroenterol. 2022 Jun 28;22(1):319. doi: 10.1186/s12876-022-02399-3.

Authors

Affiliations

¹ Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan.
² Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan. n_manabe@med.kawasaki-m.ac.jp.
³ Department of General Surgery, Kawasaki Medical School, Okayama, Japan.
⁴ Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan.
⁵ Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan.
⁶ Department of Pathology, Kawasaki Medical School, Okayama, Japan.
⁷ Department of Pathology, Kawasaki Medical School, Kurashiki, Japan.
⁸ Division of Gastroenterology, Department of Internal Medicine 2, Kawasaki Medical School, Okayama, Japan.
⁹ Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan.

Abstract

Background: To date, no in-depth studies have focused on the impact of various clinical characteristics of esophageal squamous cell carcinoma (ESCC), including its association with subjective symptoms, on patient prognosis. We aimed to investigate the clinical factors that affect the prognosis of patients with ESCC and to clarify how subjective symptoms are related to prognosis.

Methods: We retrospectively evaluated the clinical records of 503 consecutive patients with ESCC from April 2011 to December 2019. Six established prognostic factors for ESCC (body mass index, alcohol drinking, cigarette smoking, sex, clinical stage, and age) and subjective symptoms were used to subgroup patients and analyze survival differences. Next, the patients were divided into two groups: a symptomatic group and an asymptomatic group. In the symptomatic group, differences in the incidence of subjective symptoms according to tumor size, tumor location, macroscopic tumor type, and clinical stage were examined. Finally, subjective symptoms were divided into swallowing-related symptoms and other symptoms, and their prognosis was compared.

Results: Multivariate Cox regression analysis identified sex [hazard ratio (HR) 1.778; 95% CI 1.004-3.149; p = 0.049], TNM classification (HR 6.591; 95% CI 3.438-12.63; p < 0.001), and subjective symptoms (HR 1.986; 95% CI 1.037-3.803; p = 0.0386) as independent risk factors for overall survival. In the symptomatic group, the mean time from symptom onset to diagnosis was 2.4 ± 4.3 months. The incidence of subjective symptoms differed by clinical stage, and the prognosis of patients with swallowing-related symptoms was significantly worse than that of patients with other symptoms.

Conclusion: The results of this study suggest that screening by upper gastrointestinal endoscopy, independent of subjective symptoms (especially swallowing-related symptoms), may play an important role in the early detection and improvement of prognosis of ESCC, although further validation in a large prospective study is needed.

Keywords: Cancer screening; Esophageal squamous cell carcinoma; Prognosis; Symptoms.

MeSH terms

Carcinoma, Squamous Cell* / pathology
Esophageal Neoplasms* / diagnosis
Esophageal Neoplasms* / metabolism
Esophageal Squamous Cell Carcinoma*
Humans
Prognosis
Retrospective Studies