Prognostic factors for esophageal squamous cell carcinoma--a population-based study in Golestan Province, Iran, a high incidence area

• Published in: PloS one Vol. 6; no. 7; p. e22152
• Main Authors: Aghcheli, Karim, Marjani, Haji-Amin, Nasrollahzadeh, Dariush, Islami, Farhad, Shakeri, Ramin, Sotoudeh, Masoud, Abedi-Ardekani, Behnoush, Ghavamnasiri, Mohammad-Reza, Razaei, Ezzatollah, Khalilipour, Elias, Mohtashami, Samira, Makhdoomi, Yasha, Rajabzadeh, Rabea, Merat, Shahin, Sotoudehmanesh, Rasoul, Semnani, Shahryar, Malekzadeh, Reza
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 21-07-2011; Public Library of Science (PLoS)
• Subjects: Aged; Angiogenesis; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - epidemiology; Carcinoma, Squamous Cell - surgery; Chewing; Chewing tobacco; Confidence Intervals; Data processing; Demography; Development and progression; Endoscopy; Esophageal cancer; Esophageal Neoplasms - diagnosis; Esophageal Neoplasms - epidemiology; Esophageal Neoplasms - therapy; Esophagus; Ethnicity; Female; Health risk assessment; Hospitals; Humans; Incidence; Ingestion; Iran - epidemiology; Laparoscopy; Male; Mastication; Medical prognosis; Medical treatment; Medicin och hälsovetenskap; Medicine; Middle Aged; Minority & ethnic groups; Molecular biology; Narcotics; Oncology; Opium; Population; Population studies; Population-based studies; Prognosis; Proportional Hazards Models; Radiation therapy; Smoking; Squamous cell carcinoma; Survival; Survival Analysis; Tobacco; Tomography; Ultrasonic imaging; Urban areas; Iran
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0022152

Golestan Province in northern Iran is an area with a high incidence of esophageal squamous cell carcinoma (ESCC). We aimed to investigate prognostic factors for ESCC and survival of cases in Golestan, on which little data were available. We followed-up 426 ESCC cases participating in a population-based case-control study. Data were analyzed using the Kaplan-Meier method and the Cox proportional hazard models. Median survival was 7 months. Age at diagnosis was inversely associated with survival, but the association was disappeared with adjustment for treatment. Residing in urban areas (hazard ratio, HR = 0.70; 95% CI 0.54-0.90) and being of non-Turkmen ethnic groups (HR = 0.76; 95% CI 0.61-0.96) were associated with better prognosis. In contrast to other types of tobacco use, nass (a smokeless tobacco product) chewing was associated with a slightly poorer prognosis even in models adjusted for other factors including stage of disease and treatment (HR = 1.38; 95% CI 0.99-1.92). Opium use was associated with poorer prognosis in crude analyses but not in adjusted models. Almost all of potentially curative treatments were associated with longer survival. Prognosis of ESCC in Golestan is very poor. Easier access to treatment facilities may improve the prognosis of ESCC in Golestan. The observed association between nass chewing and poorer prognosis needs further investigations; this association may suggest a possible role for ingestion of nass constituents in prognosis of ESCC.