Community prevention and standardized clinical treatment jointly improve cancer outcome: Real-world evidence from an esophageal cancer patient cohort study

• Published in: Science bulletin (Beijing) 2024-12
• Main Authors: Ke, Ji, Liu, Fangfang, Yang, Wei, Xu, Ruiping, Chen, Lei, Yang, Wenlei, He, Yu, Liu, Zhen, Hou, Bolin, Zhang, Liqun, Lin, Miaoping, Zhang, Lixin, Zhang, Fan, Cai, Fen, Xu, Huawen, Liu, Mengfei, Liu, Ying, Pan, Yaqi, He, Zhonghu, Ke, Yang
• Format: Article
• Language: English
• Subjects: Esophageal squamous cell carcinoma; High-quality clinical treatment; Real-world; Survival; Tumor downstaging
• ISSN: 2095-9273
• DOI: 10.1016/j.scib.2024.11.005

[Display omitted] Extensive efforts have been put into reducing the heavy burden of esophageal squamous cell carcinoma (ESCC) in China. However, the joint impact of prevention and treatment on the long-term overall survival (OS) of ESCC patients remains largely unknown. We consecutively recruited 13,255 ESCC patients from two Chinese centers: the Northern center, located in a high-risk area with abundant screening programs; and the Southern center, situated in a non-high-risk area with improved clinical practices. Inter-center comparison, longitudinal intra-center comparison, and a simulation analysis were conducted to investigate the influence of tumor downstaging and high-quality clinical treatment on OS. During a follow-up period of 12.52 years, the Northern center exhibited higher median survival than the Southern center (6.22 vs. 3.15 years; HRadjusted = 0.73, 95% CI: 0.69–0.77). Mediation analysis demonstrated that its OS advantage was largely (77.7%) attributed to earlier TNM stage (stage 0–II: 51.3% vs. 24.6%). In temporal analyses, patient survival in the Southern center gradually improved (median survival during 2015–2018 vs. 2009–2014: 3.58 vs. 2.93 years; HRadjusted = 0.86, 95% CI: 0.79–0.94), coinciding with the progress of treatment-related indices (completeness of TNM staging in discharge diagnosis [from 53.7% to 99.6%], adoption of minimally invasive esophagectomy [from 0.0% to 51.1%] and right thoracic esophagectomy [from 12.4% to 86.4%], etc.). Simulation analysis further demonstrated that integrating both downstaging and high-quality treatment would lead to the best survival. Tumor downstaging and high-quality clinical treatment have a joint impact on ESCC patient survival. Establishing a comprehensive strategy that integrates cancer prevention with optimal clinical treatment is crucial for alleviating the ESCC burden.