Patient demographics and lifestyle factors influencing long-term survival of oesophageal cancer and gastric cardia cancer in a nationwide study in Sweden.
BACKGROUND
Little is known about the possible influence of demographic and aetiologic risk factors on the survival amongst patients with oesophageal and cardia cancer.


METHODS
In a Swedish nationwide case-control study conducted in 1995-1997, 618 patients diagnosed with oesophageal or cardia cancer were interviewed regarding demographic and lifestyle factors, and followed up for survival through a 2004. Information about the treatment was collected through review of medical records, and 38 patients with missing records were excluded. Survival curves were estimated by Kaplan-Meier method. Cox proportional hazards regression models were used to derive hazard ratios (HRs) and 95% confidence intervals (CIs), with adjustment for known or suspected prognostic factors.


RESULTS
Amongst the 580 included patients, 177 had oesophageal adenocarcinoma, 159 oesophageal squamous-cell carcinoma and 244 had cardia adenocarcinoma. Surgical resection was conducted in 224 patients (39%). The overall 5-year survival rate was 12%. Amongst patients with oesophageal adenocarcinoma, obese patients had a favourable prognosis compared to those of normal weight (HR=0.6, 95%CI 0.3-1.0). Amongst patients with oesophageal squamous-cell carcinoma, lean patients had a better prognosis (HR=0.6, 95%CI 0.4-1.0), whilst previous smokers (HR=2.1, 95%CI 1.0-4.4) and low educated (HR=1.9, 95%CI 1.1-3.4) had a worse prognosis. There were no statistically significant associations between sex, age, reflux symptoms, alcohol consumption or physical activity and prognosis in any of the three studied cancer subtypes.


CONCLUSIONS
Body mass, tobacco smoking and education might influence the long-term survival of patients with oesophageal cancer.
Sundelöf
Martin
M
Department of Clinical Sciences, Division of Surgery, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. martin.sundelof@ds.se
Lagergren
Jesper
J
Ye
Weimin
W
D000230:Adenocarcinoma / Q000401:mortality*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality*; D002299:Cardia; D016022:Case-Control Studies; D003710:Demography; D004812:Epidemiologic Methods; D004938:Esophageal Neoplasms / Q000401:mortality*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000401:mortality*; D013548:Sweden / Q000453:epidemiology