Obayo Siraji, Mulumba Yusuf, Thompson Cheryl L, Gibson Michael K, Cooney Matthew M, Orem Jackson
Uganda Cancer Institute, Upper Mulago Hill Road PO Box 3935, Kampala, Uganda.
Case Western Reserve University, Case Comprehensive Cancer Centre, Cleveland, OH 44106, USA.
Ecancermedicalscience. 2023 Jul 19;17:1576. doi: 10.3332/ecancer.2023.1576. eCollection 2023.
Oesophageal cancer is the seventh most common cancer and the sixth leading cause of cancer death worldwide, and its incidence varies globally. In Uganda, the incidence and trend are on the increase. However, there is a paucity of published data regarding this population's oesophageal cancer clinicopathologic characterisation and treatment outcomes.
To study the patients' clinicopathologic characteristics and treatment outcomes of oesophageal cancer over 10 years at the Uganda Cancer Institute.
Patients' charts with histologically confirmed diagnoses of oesophageal cancer for 2009-2019 were identified. Case information, which included patient demographics, history of alcohol use or smoking, tumour location, histological type, tumour grade, clinical TNM (Tumour, Node, Metastasis) staging treatment exposure and treatment outcomes, was evaluated retrospectively. The median survival time was estimated with the Kaplan-Meier method and the median follow-up period was estimated using the reverse Kaplan-Meier.
1,965 oesophageal cancer patients were identified; 1,380(70.23%) were males and 585(29.77 %) females, their mean age was 60.20 years (±12.66). Most males had a history of both alcohol consumption and smoking 640(46.38%). The lower third of the oesophagus was the most common anatomical location 771(39.24%). The majority had squamous cell carcinoma histological type 1,783(90.74%) followed by adenocarcinomas 182(9.26%) in the distal oesophagus. Poorly differentiated tumour grade 743(37.81%) was predominant. The majority of the patients were in stage IVB, 733(37.30%), and most patients were planned for the best supportive care, 731(37.20%). Radiation alone was offered to 621(31.60%) and feeding gastrostomy to 249(12.70%). Treatment outcomes: at the time of the current analysis, 58.68% had died, 1.48% were alive and 39.84% were lost to follow-up. The median follow-up period was 65 months (IQR:35.83-83.30) with a median survival time of 4.47 months (95% CI: 4.17-4.80).
Treatment outcomes of Ugandan oesophageal cancer patients seeking care are poor as most patients present with advanced disease. There is a significant loss of follow-up after treatment initiation. Therefore, reduction in exposure to known modifiable risk factors, early detection and timely referral for treatment strategies are needed to improve outcomes of these patients in our population. Designing interventions to improve treatment adherence is necessary.
食管癌是全球第七大常见癌症，也是癌症死亡的第六大主要原因，其发病率在全球范围内各不相同。在乌干达，发病率和发病趋势呈上升态势。然而，关于该人群食管癌的临床病理特征和治疗结果，公开数据匮乏。
研究乌干达癌症研究所10年间食管癌患者的临床病理特征及治疗结果。
确定2009 - 2019年组织学确诊为食管癌患者的病历。回顾性评估病例信息，包括患者人口统计学资料、饮酒或吸烟史、肿瘤位置、组织学类型、肿瘤分级、临床TNM（肿瘤、淋巴结、转移）分期、治疗暴露情况及治疗结果。采用Kaplan - Meier法估计中位生存时间，使用反向Kaplan - Meier法估计中位随访期。
共识别出1965例食管癌患者；男性1380例（70.23%），女性585例（29.77%），平均年龄为60.20岁（±12.66）。大多数男性有饮酒和吸烟史，共640例（46.38%）。食管下三分之一是最常见的解剖位置，共771例（39.24%）。多数患者为鳞状细胞癌组织学类型，共1783例（90.74%），其次是远端食管腺癌182例（9.26%）。低分化肿瘤分级占主导，共743例（37.81%）。大多数患者处于IVB期，共733例（37.30%），且大多数患者计划接受最佳支持治疗，共731例（37.20%）。仅接受放疗的有621例（31.60%），接受胃造瘘术的有249例（12.70%）。治疗结果：在当前分析时，58.68%的患者已死亡，1.48%的患者存活，39.84%的患者失访。中位随访期为65个月（IQR：35.83 - 83.30），中位生存时间为4.47个月（95%CI：4.17 - 4.80）。
寻求治疗的乌干达食管癌患者治疗结果不佳，因为大多数患者就诊时已处于晚期疾病阶段。治疗开始后有显著的失访情况。因此，需要减少接触已知的可改变风险因素、早期检测并及时转诊以采取治疗策略，从而改善我国这些患者的治疗结果。设计干预措施以提高治疗依从性是必要的。
