Patterns of Esophageal Cancer Stage at Diagnosis: A Systematic Review of Registry-Based Data

Stage at diagnosis is a key factor influencing survival in patients with esophageal cancer. This study aims to assess the distribution of esophageal cancer stage at diagnosis using registry data from multiple countries/regions.

PubMed, Embase, CNKI, and WanFang Data were systematically searched, supplemented by grey literature from cancer registry reports. Population- or hospital-based registry studies reporting stage distribution at diagnosis according to tumor-node-metastasis or Surveillance, Epidemiology, and End Results systems were included. Sex-specific stage distributions, associations of the Human Development Index (HDI) and Socio-Demographic Index (SDI) with distant metastasis, and temporal trends in stage distribution were assessed.

Stage data from 23 countries/regions were included. Among the 22 countries/regions in the primary analysis, the proportion of cases with distant metastasis varied substantially, with a median of 26.6% (interquartile range: 18.7%-35.9%), highest in Czechia (43.7%). Among the 11 countries with sex-stratified data, males had a higher proportion of distant metastasis than females in all but Norway. Weighted ecological analyses showed no statistically significant associations of HDI or SDI with the proportion of cases with distant metastasis (p > 0.05). Temporal trends showed that the proportion of distant metastasis remained generally stable in most countries/regions, with the Republic of Korea below 20%.

A substantial proportion of patients with esophageal cancer presented with distant metastasis at diagnosis, with marked regional and sex differences in stage distribution. Further research is needed to identify factors associated with stage variation and improve cancer registration and staging data quality.