Supervivencia en Cáncer de Esófago Post-Endoscopia: Un Estudio de Cohorte Poblacional Nórdico

Post-endoscopy esophageal cancer (PEEC), i.e., esophageal cancer diagnosed shortly after an endoscopy in which no cancer was found, constitutes about 5-10% of all esophageal cancers. The long-term survival in PEEC has previously not been reported.

This population-based cohort study included all patients with a newly diagnosed esophageal cancer in Denmark, Finland, or Sweden between 2004-2022. Patients with PEEC, i.e., a history of upper endoscopy between 6-36 months before esophageal cancer diagnosis, were compared with all other esophageal cancer, i.e., those without upper endoscopy 6-36 months before diagnosis. The outcomes were 5-year disease-specific mortality and 5-year all-cause mortality. Multivariable Cox regression was used to calculate hazard ratios (HR) with 95% confidence intervals (95% CI), adjusted for country, age, sex, calendar year, comorbidity and tumor histology.

Among all 27,309 study patients with esophageal cancer, 1588 (5.8%) were classified as PEEC. The cumulative 5-year mortality among patients with PEEC was 74.6% (n=1185), and 79.6% of the deaths (n=943) were disease-specific. PEEC was associated with decreased risks of both 5-year disease-specific mortality (HR 0.72, 95% CI 0.68-0.77) and 5-year all-cause mortality (HR 0.74, 95% CI 0.71-0.80). Stratified analysis found that the decreased 5-year disease-specific mortality in PEEC was limited to patients with adenocarcinoma (HR 0.57, 95% CI 0.52-0.62), whereas no such decrease was found among patients with squamous cell carcinoma (HR 1.04, 95% CI 0.95-1.15).

The 5-year survival in patients with PEEC seems to be better than in those with other esophageal cancer, but the survival is still poor.