title: Impact of alcohol consumption on survival in patients with esophageal carcinoma: a large cohort with long-term follow-up.
abstract: Alcohol is a well-established cause of esophageal carcinoma, but its effect on survival is little known and contradictory. To clarify whether drinking is an independent predictor of survival in esophageal carcinoma, 2151 Chinese patients, receiving surgical resection from January 1997 to December 2008, were followed until March 2014. Cox proportional hazards analysis was applied to evaluate the prognostic effect of alcohol consumption. The median follow-up was 64 months. The median overall survival (OS; 42 months) and disease-free survival (DFS; 33 months) for never-drinkers were significantly higher than ever-drinkers (27 and 22 months, respectively). In the multivariate Cox model that was adjusted for age, weight loss, stage according to criteria set by the American Joint Committee on Cancer, radicality of surgery, adjuvant treatment, smoking status, and gender, the hazard ratios of ever-drinking were 1.22 (1.06-1.41, P = 0.005) on OS, and 1.16 (1.01-1.34, P = 0.037) on DFS. The hazardous effect on OS and DFS of drinking grew statistically significantly in a dose-dependent manner with increasing amount of alcohol consumption per day (both P-value for trend < 0.05). The predictive effect of drinking on OS (P = 0.596) or DFS (P = 0.207) was not significant in the subgroup with esophageal adenocarcinoma (n = 195). The current study revealed that the survival is shortened, of those patients who consume alcohol before diagnosis of esophageal squamous cell carcinoma, which are not attributable to differences in stage, smoking status, and gender. Alcohol control should be emphasized to reduce mortality of esophageal carcinoma, and further outcome studies should include alcohol as a potential prognosticator.
authors.affiliation: Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Guangdong Esophageal Cancer Institute, Guangzhou, China.
authors.forename: Qingyuan
authors.initials: Q
authors.lastname: Huang
authors.forename: Kongjia
authors.initials: K
authors.lastname: Luo
authors.forename: Hong
authors.initials: H
authors.lastname: Yang
authors.forename: Jing
authors.initials: J
authors.lastname: Wen
authors.forename: Shuishen
authors.initials: S
authors.lastname: Zhang
authors.forename: Jinhui
authors.initials: J
authors.lastname: Li
authors.forename: Amos
authors.initials: A
authors.lastname: Ela Bella
authors.forename: Qianwen
authors.initials: Q
authors.lastname: Liu
authors.forename: Fu
authors.initials: F
authors.lastname: Yang
authors.forename: Yuzhen
authors.initials: Y
authors.lastname: Zheng
authors.forename: Ronggui
authors.initials: R
authors.lastname: Hu
authors.forename: Junying
authors.initials: J
authors.lastname: Chen
authors.forename: Jianhua
authors.initials: J
authors.lastname: Fu
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology; D002681:China; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis
keywords: Alcohol; esophageal cancer; esophagectomy; prognosis; survival