2001 - Influence of Tumor Locations on the Survival of Patients with Esophageal Squamous Cell Carcinoma

03:00pm - 04:00pm ET

Poster Hall - Exhibit Hall A

Screen: 20

POSTER

Presenter(s)

Dashan Ai, MD - Fudan University Shanghai Cancer Center, Shanghai, Shanghai

D. Ai¹, J. Q. Chen², X. Wang³, L. N. Zhao⁴, W. Shen⁵, W. Zhang⁶, H. Luo⁷, Q. Wang⁸, Y. Xu⁹, S. Hao¹⁰, Y. Chen¹, Q. Liu¹, S. Zhang¹, and K. L. Zhao¹¹; ¹Fudan University Shanghai Cancer Center, Shanghai, China, ²Department of Radiation Oncology, Fujian Cancer Hospital/Fujian Medical University Cancer Hospital, Fuzhou, China, ³Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China, ⁴Department of Radiation Oncology,Xijing Hospital,Air Force Medical University CN, xi'an, China, ⁵The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China, ⁶Tianjin Medical University Cancer Institute & Hospital, Tianjin, China, ⁷The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai‘an, China, ⁸Department of Radiation Oncology, Sichuan Cancer Hospital and Institution, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, Sichuan, China, ⁹Fujian Cancer Hospital, Fuzhou, Fujian, China, ¹⁰Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China, Shanghai, China, ¹¹Fudan University Cancer Center, Shanghai, China

Purpose/Objective(s):

Tumor location has been a determining factor in the TNM staging system since 2009. However, its impact on survival remains unclear, especially when considering different treatment modalities. This study aimed to evaluate the effect of primary tumor location on survival in patients with esophageal squamous cell carcinoma (ESCC) treated with radiotherapy (without surgery) or surgery (without radiotherapy).

Materials/Methods: We analyzed two independent multi-center retrospective cohorts: a radiotherapy cohort (n=2,773) and a surgery cohort (n=1,153), both comprising patients with locoregional ESCC. Multivariate Cox regression was used to assess the impact of tumor location (upper, middle, lower) on overall survival, adjusting for sex, age, stage, grade, and diagnosis period. These findings were externally validated using data from the Surveillance, Epidemiology, and End Results (SEER) database (1973–2013).

Results:

In the radiotherapy cohort, upper ESCC was associated with the best survival, followed by middle (HR, 1.260; P<0.001) and lower ESCC (HR, 1.514; P<0.001). Conversely, in the surgery cohort, lower ESCC showed a trend toward better survival compared to upper ESCC (HR, 0.726; P=0.078), though the overall effect was not statistically significant (P=0.178). Validation using the SEER database confirmed these trends: among radiotherapy-only patients, upper ESCC had the best prognosis, while among surgery-only patients, lower ESCC had significantly better survival.

Conclusion:

Our study demonstrates that the association between tumor location and survival is significantly modified by treatment modality. Superior outcomes are observed for upper esophageal cancers treated with radiotherapy and for lower esophageal cancers treated with surgery. These findings underscore the importance of integrating primary tumor site into personalized treatment planning and informing future TNM classifications for ESCC.