Patient demographics and lifestyle factors influencing long-term survival of oesophageal cancer and gastric cardia cancer in a nationwide study in Sweden

Background: Little is known about the possible influence of demographic and aetiologic risk factors on the survival amongst patients with oesophageal and cardia cancer. Methods: In a Swedish nationwide case-control study conducted in 1995-1997, 618 patients diagnosed with oesophageal or cardia cancer were interviewed regarding demographic and lifestyle factors, and followed up for survival through a 2004. Information about the treatment was collected through review of medical records, and 38 patients with missing records were excluded. Survival curves were estimated by Kaplan-Meier method. Cox proportional hazards regression models were used to derive hazard ratios (HRs) and 95% confidence intervals (CIs), with adjustment for known or suspected prognostic factors. Results: Amongst the 580 included patients, 177 had oesophageal adenocarcinoma, 159 oesophageal squamous-cell carcinoma and 244 had cardia adenocarcinoma. Surgical resection was conducted in 224 patients (39%). The overall 5-year survival rate was 12%. Amongst patients with oesophageal adenocarcinoma, obese patients had a favourable prognosis compared to those of normal weight (HR = 0.6, 95%CI 0.3-1.0). Amongst patients with oesophageal squamous-cell carcinoma, lean patients had a better prognosis (HR = 0.6, 95%CI 0.4-1.0), whilst previous smokers (HR = 2.1, 95%CI 1.0-4.4) and low educated (HR = 1.9, 95%CI 1.1-3.4) had a worse prognosis. There were no statistically significant associations between sex, age, reflux symptoms, alcohol consumption or physical activity and prognosis in any of the three studied cancer subtypes. Conclusion: Body mass, tobacco smoking and education might influence the long-term survival of patients with oesophageal cancer. (C) 2008 Elsevier Ltd. All rights reserved.