Characteristics and prognosis according to tumor location in esophageal squamous cell carcinoma

This study aimed to analyze location-specific characteristics and prognosis of esophageal squamous cell carcinoma (ESCC).

Medical records of patients with ESCC between December 2008 and December 2024 at Pusan National University Yangsan Hospital were retrospectively reviewed. A total of 497 patients with ESCC were included in the study and classified into three groups based on tumor location: upper esophagus (n = 107), middle esophagus (n = 224), and lower esophagus (n = 166). The clinical characteristics at diagnosis and prognosis were compared among these groups.

Patients with upper esophageal cancer were the oldest at the time of diagnosis (median age 70 years, p = 0.041) and were more frequently diagnosed at an advanced stage (T4 stage: 12.1%, p = 0.006). Patients with middle ESCC were diagnosed at the earliest stage (T1 stage: 48.7%, p < 0.001). Patients with lower ESCC had the highest incidence of distant metastasis at diagnosis (22.3%, p = 0.012). Overall survival was significantly lower in patients with upper ESCC (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.41-2.67; p < 0.001) and lower ESCC (HR, 1.59; 95% CI, 1.18-2.13; p = 0.002) compared to those with middle ESCC.

Endoscopists should be particularly vigilant to avoid missing upper ESCC, and careful consideration should be given to the potential for distant metastasis in lower ESCC.