Survival in post-endoscopy esophageal cancer: a Nordic population-based cohort study

Background: Post-endoscopy esophageal cancer (PEEC) (i.e. esophageal cancer diagnosed shortly after an endoscopy in which no cancer was found) constitutes about 5%-10% of all esophageal cancers. Long-term survival in PEEC has not been reported previously. Methods: This population-based cohort study included patients with a newly diagnosed esophageal cancer in Denmark, Finland, and Sweden between 2004 and 2022. Patients with PEEC (i.e. history of upper endoscopy 6-36 months before esophageal cancer diagnosis) were compared with patients with all other esophageal cancers (i.e. those without upper endoscopy 6-36 months before diagnosis). Outcomes were 5-year disease-specific mortality and 5-year all-cause mortality. Multivariable Cox regression was used to calculate hazard ratios (HRs) with 95%CIs, adjusted for country, age, sex, calendar year, comorbidity, and tumor histology. Results: Among 27 309 patients with esophageal cancer, 1588 (5.8%) were classified as having PEEC. The cumulative 5-year mortality among patients with PEEC was 74.6% (n = 1185), and 79.6% of these were disease-specific deaths (n = 943). PEEC was associated with decreased risks of both 5-year disease-specific mortality (HR 0.72, 95%CI 0.68-0.77) and 5-year all-cause mortality (HR 0.74, 95%CI 0.71-0.80). Stratified analysis found that the decreased 5-year disease-specific mortality in PEEC was limited to patients with adenocarcinoma (HR 0.57, 95%CI 0.52-0.62), whereas no such decrease was found among patients with squamous cell carcinoma (HR 1.04, 95%CI 0.95-1.15). Conclusions: 5-year survival in patients with PEEC seemed to be better than in those with other esophageal cancer, but the survival was still poor.