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Journal of Cancer Research and Therapeutics, Vol. 7, No. 2, April-June, 2011, pp. 135-137 Original Article Esophageal cancer: 5-year survival rate at south-east of Caspian sea of northern Iran Mohammad Hussin Taziki1, Siamak Rajaee2, Naser Behnampour3, Massoud Tadrisee4, Azad Reza Mansourian5 1 Department of ENT, Gorgan Medical School, Gorgan, India Code Number: cr11032 PMID: 21768698 Abstract Background: Locating at southern margin of Caspian sea and Asian esophagus cancer cordon Golestan state is one of the most common sites of this cancer.Objective: This study designed to evaluate the 5-years survival rate of esophagus cancer. Materials and Methods: 55 patients with esophagus cancer diagnosed by pathologic examination, age, gender, type of tumor, clinical manifestation on the time of tumor metastases, treatment and patient survival time studied. The collecting data were analyzed by SPSS 11.5, and life table and Kaplan Meier methods were applied. Results: 55 patients studied included 11 females and 44 males respectively with average survival life time of 12.8 months for the 5-year survival rate for patients diagnosed at early stage was 0.025, patients with systemic symptoms such as weight loss was 0.00. Far metastases adverse effect on highest survivals was observed among patients who underwent surgery; the survival rate for such patients was about 0.014. Conclusions: Esophageal cancer is high in southern margin of Caspian Sea, it is suggested to design studies to find the probable risk factors and the screening tests for on-time diagnosis. Keywords: 5-years survival rate, early diagnosis, northern Iran, esophagus cancer Introduction Esophageal cancer is one of the killer cancers. It is the eighth, most common cancer worldwide, which comprises 4% of all cancers which can be found in the world. [1] It is the third most prevalent cancer of the gastrointestinal system, and it is also among the six factors of mortality due to cancer. It is reported that 5.5% of all death-related cancers are due to esophageal cancers. [2] The incidence of esophageal cancer is well distributed all over the world. [3],[4] The prevalence of this cancer is different in various part of the world, and is most commonly seen in northern Iran, [5] which is itself part of esophageal cancer belt, which comprises of central Asia, Russia, and Mongolia. The esophageal incidence is also high in the Turkmen region of south east of Caspian Sea of Iran; [4] also the other types of gastrointestinal cancers seems to be high in this region. [5] The esophageal cancer is disease of middle age and elderly age, particularly of white origin and it rarely occurs among children and adolescences. It is also more commonly is seen among men. [2],[5],[6],[7] The risk factors associated with esophageal cancer are hot tea and coffee, the nitroamines, present in hot food substances, alcohol and tobacco consumptions. Dysphagia is an initial sign, with gradual weight reductions. The MRI-CTS, endoscopy, radiography, and sonography are the techniques which are used for the diagnosis and the determination of diseases in addition to taking history and medical examination, but the definite tool for the clinical diagnosis is through biopsy. Surgery, chemotherapy, radiotherapy and palliative measure are among the medical treatments. [1],[8],[9],[10] The patient survivals are different depending on the type of tissue, age, gender, type of treatment, and disease progress in different tissues. The early diagnosis with screening measures has increased the patients′ survival age. [11] This research project was designed due to the high prevalence of esophageal cancer in Golestan Province in northern Iran, to determine the 5-year survival rate of patients with esophageal cancer and its association with some factors in this region of Iran, which is globally known to have a high prevalence of esophageal cancer. [12] Material and Methods This study was a cohort study, which was carried out to establish the 5 years survival rate of esophageal cancer with at least 5 years from the patient cancer diagnosis which is based on the initial histological report. 5 patients randomly and accidentally were chosen from the histopathological laboratories files of the patients. A questionnaire was filled for each patient. In case groups, a patient was already dead; the questionnaire was filled by their next of kin; the questionnaire in addition to the demographic information consist of medical records, clinical symptoms, type of tissue involved, the time of first complain and physician visit and medical measures to diagnose, and medical regiments. Those patients, of whom the research team could not take the proper and complete information, were excluded from this study. The gathered information was entered into computer and analyzed by SPSS statistical software. For analysis of the data, life expectancy and Kaplan- Meer equation were used. How were the cases selected? The documentations and files of esophageal cancer patients which were available at the hospital and related health centers within the north-east of Iran were used as the data for this study. The data of cancer patients were gathered and extracted out of the files. The primary diagnosis was based on endoscopies and biopsy findings prior to operation, and definite diagnosis was only obtained after the surgical operation was done. Limitation of study What was the criterion for differentiation between various stages of esophagus cancers. The clear diagnosis cannot be demonstrated at the time of biopsy that whether the tumor location either belong to the one-third of lower esophagus, or the cardiac region. It also should be mentioned that in principle the approach to the esophagus cancer surgery is discussed occasionally as a single parameter to look after. What kind of therapies the cases have had The bases for selection of either curative or palliative of esophagus cancer patients were based on the position of the tumor, the patients health condition, age, the cancer progress, and the cancerous stage. In this study all the therapies which were aimed for the patients were palliative. In the one-third of lower thoracic and cardiac, the margin of 10 cm was applied for surgical operation. It should also be mentioned again that the therapy for the patients was palliative in nature and our patients underwent operation for the palliative purposes. Results Out of 55 patients, 11(20%) were females and 44(80%) were males. The average age of survival age for esophageal cancer was determined to be 12.8 months. The survival rate were studied according to gender and it was clear that the probably survival rates for men in the first month and during 2 months and during the 5-years were 1, 0.5, and 0.045, respectively, but among women up to 4 months, 9 months, and 20 months they were reported to be 1.00, 0.60, and 0.00, respectively. In general there was no statistical difference in the survival rate among men and women, when taking into consideration the age groups and various therapeutic regiments. Although it was found that the highest survival rate belonged to 55-60 years of age, a correlation was not found between age and survival rate. The relationship between the tumor and survival rate was studied, and it was found that the survival rates of patients after 10 months and 5 years were 0.50 and .058, respectively; however, in some other cases the survival rates were 0.5 and 0.00, respectively. The relationship between clinical symptoms at the time of clinical diagnosis and 5-year survival rate was studied and it was found that those patients referred with dysphagia and weight reduction showed 0.025 and 0.00 survival rate respectively. The 5 year of survival rate for those patients at the time of referring to clinician without any proper metastases was shown to be 0.058 and those patients with proper metastasis their 20-month survival rate was 0.00. In this study it was found that those patients who did not have any therapeutic regiment showed a 0.00 survival rate of 14 months, but those with surgical operation showed 14% survival rate of 5-year life expectancy. [Table - 1] and [Table - 2] summarized some other findings of the present study. Discussion In this study, the men:women ratio was 4:1, which was higher compared to other studies in some other part of northern Iran, European and northern America; also those studies indicated that under any condition, the prevalence of the cancer is higher among men. [3],[12],[13] The probability can be related to the shorter small size population in our study; also many believe the esophageal cancer to be globally distributed, but still there are some reports indicating it as the disease of poor, a case which should be taken under consideration. [8] In our study, the average survival rate of esophageal cancer was 12.8 months. In other study, in the central part of northern Iran, the survival rates of 1 or 2 years of patients with this cancer were 0.42, 0.21, 0.08, respectively, while in Europe the 5-year survival rate of esophageal cancer was reported to be 0.05. [3],[6],[12] In our study, the chance of men survival in the first month, 8 month, and after 5 years were 1, 0.5, and 0.045, respectively, while women survival rate up to 4 months, 9 months, and 20 month were 100, 0.6, and 0.00, respectively. In this study, there was no particular correlation between gender and survival rate even when considering all the existing elements although in some study in central northern Iran and in Japan, gender was determined as one of the intervening factors and was found that the survival rate of women with esophageal cancer is better than men with the same cancer, but in other study gender did not play any important role in this regards. [4],[6],[12],[14] Also, in our study we did not find any relation between age and survival rate but the highest rate of survival was among 50-60 years of age, also some other study in the northern Iran, found the patient of under 50 years had better survival rate. There are also some reports that have indicated that survival rate is independent of age. [7] But another study showed that patients of less than 35 years had lower survival rate. In our study, patients, who did not use any therapeutic treatment, showed 0.00 survival rate, their 14 months survival rate was determined to be 0.00 but those patients, under gone surgical operation, had 0.14 survival rate of 5 years life expectancy which is in agreement with study in Japan whom their patients, were also underwent surgical operation, and it seemed surgery increases the survival rate. [15] In a study by Earlam et al radiotherapy was shown to be a more useful medical procedure than surgical operation. [8],[16],[17] Also other reports indicated that the combination of various modes including radiotherapy should be applied. [3],[17],[18] In our study, the 5-year survival rate of our patients, which on the first visit, did not show any metastases and was 0.058 for those patients with far distance metastases. The survival rate of 21 months was recorded to be 0.00. In another study by Bowreo et al., it was demonstrated that the tumor surgical operation and the tumor phase are among the meaningful factors, considered to influence the survival rate of esophageal cancer positively. [3],[7],[16] In our study the chance of survival rate for various form of esophageal cancers starts from 0.00 to 0.058 according to the severity of cancer. [12],[10] Conclusion In regard to low survival rate among esophageal cancer, and its high prevalence in south-east, region of Caspian sea of northern Iran, and the importance of early diagnosis in the increasing survival rate of cancer patients, screening examinations, and cohort studies, to find out the probable risk factors, and how to reform the life style, for the reducing the prevalence of esophageal cancer in this region of Iran is strongly recommended. References
Copyright 2011 - Journal of Cancer Research and Therapeutics The following images related to this document are available:Photo images[cr11032t2.jpg] [cr11032t1.jpg] |
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