Temporal trends in long-term survival and cure rates in esophageal cancer: A SEER database analysis

Purpose: To assess long-term temporal trends in population-based survival and cure rates in patients with esophageal cancer and compare them over the last 3 decades in the United States. Methods: We identified 62,523 patients with cancer of the esophagus and the gastric cardia diagnosed between 1973 and 2007 from the Surveillance, Epidemiology, and End Results database. Longterm cancer-related survival and cure rates were calculated. Stageby-stage disease-related survival curves of patients diagnosed in different decades were compared. Influence of available variables on survival and cure was analyzed with logistic regression. Results: Ten-year survival was 14% in all patients. Disease-related survival of esophageal cancer improved significantly since 1973. Median survival in Surveillance, Epidemiology, and End Results stages in local, regional, and metastatic cancers improved from 11, 10, and 4 months in the 1970s to 35, 15, and 6 months after 2000. Early stage, age 45 to 65 years at diagnosis and undergoing surgical therapy were independent predictors of 10-year survival. Cure rate improved in all stages during the study period and were 73%, 37%, 12%, and 2% in stages 0, 1, 2, and 4, respectively, after the year 2000. Percentage of patients undergoing surgery improved from 55% in the 1970s to 64% between 2000 and 2007. Proportion of patients diagnosed with in situ and local cancer remains below 30%. Conclusion: Long-term survival with esophageal cancer is poor but survival of local esophageal cancer improved dramatically over the decades. Complete cure of nonmetastatic esophageal cancer seems possible in a growing number of patients. Early diagnosis and treatment are crucial.