title: Prognostic factors for esophageal squamous cell carcinoma--a population-based study in Golestan Province, Iran, a high incidence area.
abstract: Golestan Province in northern Iran is an area with a high incidence of esophageal squamous cell carcinoma (ESCC). We aimed to investigate prognostic factors for ESCC and survival of cases in Golestan, on which little data were available. We followed-up 426 ESCC cases participating in a population-based case-control study. Data were analyzed using the Kaplan-Meier method and the Cox proportional hazard models. Median survival was 7 months. Age at diagnosis was inversely associated with survival, but the association was disappeared with adjustment for treatment. Residing in urban areas (hazard ratio, HR = 0.70; 95% CI 0.54-0.90) and being of non-Turkmen ethnic groups (HR = 0.76; 95% CI 0.61-0.96) were associated with better prognosis. In contrast to other types of tobacco use, nass (a smokeless tobacco product) chewing was associated with a slightly poorer prognosis even in models adjusted for other factors including stage of disease and treatment (HR = 1.38; 95% CI 0.99-1.92). Opium use was associated with poorer prognosis in crude analyses but not in adjusted models. Almost all of potentially curative treatments were associated with longer survival. Prognosis of ESCC in Golestan is very poor. Easier access to treatment facilities may improve the prognosis of ESCC in Golestan. The observed association between nass chewing and poorer prognosis needs further investigations; this association may suggest a possible role for ingestion of nass constituents in prognosis of ESCC.
authors.affiliation: Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Karim
authors.initials: K
authors.lastname: Aghcheli
authors.forename: Haji-Amin
authors.initials: HA
authors.lastname: Marjani
authors.forename: Dariush
authors.initials: D
authors.lastname: Nasrollahzadeh
authors.forename: Farhad
authors.initials: F
authors.lastname: Islami
authors.forename: Ramin
authors.initials: R
authors.lastname: Shakeri
authors.forename: Masoud
authors.initials: M
authors.lastname: Sotoudeh
authors.forename: Behnoush
authors.initials: B
authors.lastname: Abedi-Ardekani
authors.forename: Mohammad-Reza
authors.initials: MR
authors.lastname: Ghavamnasiri
authors.forename: Ezzatollah
authors.initials: E
authors.lastname: Razaei
authors.forename: Elias
authors.initials: E
authors.lastname: Khalilipour
authors.forename: Samira
authors.initials: S
authors.lastname: Mohtashami
authors.forename: Yasha
authors.initials: Y
authors.lastname: Makhdoomi
authors.forename: Rabea
authors.initials: R
authors.lastname: Rajabzadeh
authors.forename: Shahin
authors.initials: S
authors.lastname: Merat
authors.forename: Rasoul
authors.initials: R
authors.lastname: Sotoudehmanesh
authors.forename: Shahryar
authors.initials: S
authors.lastname: Semnani
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D016001:Confidence Intervals; D003710:Demography; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis