Esophageal cancer is the sixth leading cause of cancer death worldwide with considerable geographical histological variation There is a paucity of data in esophageal cancer in demographics, histology, and survival among the multi-ethnic Malaysian population. This paper is a review of esophageal cancer epidemiology and survival among esophageal cancer patients from data collected by the Malaysian Upper Gastrointestinal Surgical Society.
This is a multicenter retrospective observational study of esophageal cancer patients from six upper gastrointestinal surgical centers in Malaysia between 2005 and 2019. Patient characteristics, histological type and stage were compared and survival analyzed.
There were 820 patients with esophageal cancer included, where 442 (53.9 %) cases had squamous cell carcinoma (SCC) and 378 (46.1 %) had adenocarcinomas (AC). Malays were the predominant ethnicity with AC (66.7 %) while Indians were the ethnic majority (74.6 %) with SCC. Majority of patients (56.8 %) presented as stage IV disease. Overall, the 1-, 3-, and 5-years’ survival were 35.8 %, 13.8 % and 11.0 %, respectively. Surgical resection with curative intent yielded the best 5-year survival (29.4 %). Intervention in stage IV AC yielded superior survival when compared to SCC (median survival, 7.9 months vs 4.8 months; p , 0.018) Our series demonstrated an increase in AC to SCC over the last 15 years.
There was an ethnic preponderance seen between different histology in this region, not previously discussed. An increase in AC was observed over the last 15 years. Late diagnosis seen in most patients imparts poor prognosis as curative surgery affords the best outcome.
- • Histology preponderance varies between different Asian ethnicities in Malaysia.
- • There is a regional increase in proportion of esophageal adenocarcinoma over the past 15 years.
- • Most patients in this region still present late.
Esophageal cancer affected more than 572,000 people in 2018, responsible for more than 508,000 deaths, contributing 5.3 % of all cancer deaths globally . The incidence continued to rise with growing and aging population . The incidence and histological types were variable depending on geographical location and socioeconomic status of the population . Esophageal squamous cell carcinoma (SCC) remained the commonest histological subtype in East Asia, with distribution extending from China to Middle East. The incidence of adenocarcinoma (AC) among esophageal cancer patients had increased over the years, predominantly in countries among those with higher socioeconomic status. . Malaysia is unique with its diverse multiethnic population comprising three main ethnicities. The majority of the population were the Malay ethnic and natives (69.8 %), with two other major Asian ethnicities, that is, Chinese (22.4 %) and Indian (6.8 %) . The Malaysia National Cancer Registry (MNCR) showed that, Indian men and women were found to have the highest age-standardized rate (ASR) of esophageal cancer, that is, 2.4 and 2.1 per 100,000 population respectively . Most esophageal cancer patients in Malaysia presented late with advanced disease, where 26.4 % were stage III and more than half (53.9 %) were stage IV disease. . However, paucity of data remains with regards to the histological difference between ethnicities as well as survival and mortality in this part of the world.
This collaborative study organized by Malaysia Upper Gastrointestinal Surgical Society (MUGIS) aims to study the ethnic and histological differences in the Malaysian population, analyzing the trend and associated survival over the past 15 years, between 2005 and 2019.