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Stage-specific survival from esophageal cancer in China and implications for control strategies: a systematic review and meta-analyses

  • Yu He
    Affiliations
    Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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  • Manuela Quaresma
    Affiliations
    Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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  • Isabel dos-Santos-Silva
    Correspondence
    Correspondence: Professor Isabel dos-Santos-Silva, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK. Tel: 44(0)20 7927 2113; Fax: 44(0)20 7580 6897;
    Affiliations
    Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Open AccessPublished:October 30, 2022DOI:https://doi.org/10.1016/j.gastha.2022.10.012
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      Background & Aims

      Esophageal cancer claims over 500,000 deaths worldwide, with half occurring in China. We aimed to synthesise existing evidence on stage-specific survival from this cancer in China to inform cancer control strategies.

      Methods

      English and Chinese literature databases were systematically searched to identify original research published up to 31 May 2019 that reported stage-specific survival from esophageal cancer in China. Two meta-analyses were performed using random-effects models to summarise stage-specific survival differences on relative and absolute scales. The number of oesophageal cancer deaths that might have been prevented by early detection in China, in 2018, was estimated assuming two different downstaging scenarios.

      Results

      150 eligible studies were identified, 97 had non-overlapping study populations (83,063 participants), 47 were included in the meta-analysis of hazard ratios and 26 in the meta-analysis of survival probabilities. Late-stage (III–IV) was associated with 92% higher hazard of death compared with early-stage (0–II) (95% CI 1.62–2.28), corresponding to an absolute 5-year survival difference of 31.2% (29.9–32.4%). In all, 5.2% esophageal cancer deaths could have been prevented in China, in 2018, if the observed stage distribution at diagnosis (∼50% early-stage) were shifted to the real-life conditions of a population-based endoscopic screening program (∼60% early-stage) and 26.9% if shifted to that observed in the controlled setting of a randomised trial (∼90% early-stage).

      Conclusions

      Shifting downwards the stage distribution of esophageal cancer through screening would bring moderate reductions in mortality from the disease. Treatment improvements for early-stage patients are needed to reduce further mortality from this cancer.

      Keywords

      Abbreviations used in this paper:

      AC (adenocarcinoma), AJCC (American Joint Committee on Cancer), EC (esophageal cancer), HR (hazard ratio), IPD (individual patient data), KM (Kaplan-Meier), SCC (squamous cell carcinoma), UICC (Union for International Cancer Control)