Esophageal Carcinoma Incidence and Survival Analysis: A Population-Based Cancer Registry Study in Central India.

INTRODUCTION: This study aimed to estimate the incidence, mortality, and overall survival (OS) of esophageal cancer (EC) and to evaluate the association of clinicopathological characteristics and treatment modality with OS.

METHODS: A retrospective observational cohort study was conducted using data from the Population-Based Cancer Registry (PBCR) in rural central India. The dataset included 545 incident EC cases registered between 2010 and 2019, of which 476 were eligible for OS analysis. Incidence and mortality rates were estimated, OS was analyzed using the Kaplan-Meier method, and Cox proportional hazards regression was used to identify prognostic factors. Prespecified sensitivity analyses, including metastasis-adjusted and age-stratified Cox regression models, were performed to assess the robustness of the primary multivariable findings.

RESULTS: The age-standardized incidence rate (ASIR) of overall EC cases was 3.99 per 100,000 population (95% CI: 3.50-4.47), while the age-standardized mortality rate (ASMR) was 3.29 per 100,000 population (95% CI: 2.94-3.64). The overall median survival was 178.33 days (95% CI: 115.49-234.48). The OS rates at 1, 3, 5, and 10 years were 31.3%, 19.7%, 17.4%, and 14.6%, respectively. OS differed significantly according to tumor site (χ² = 5.24, p = 0.043), treatment modality (χ² = 15.42, p = 0.031), and metastatic status (χ² = 162.64, p < 0.001) on Kaplan-Meier analysis. Median survival was 232 days (95% CI: 159.59-304.41) for localized disease, 199 days (95% CI: 166.38-231.61) for regional disease, 68 days (95% CI: 54.21-81.79) for distant disease, and 28 days (95% CI: 15.56-40.44) for advanced disease. On univariable Cox regression, patients with middle-third tumors had a lower hazard of death than those with upper-third tumors (HR: 0.74, 95% CI: 0.56-0.98; p = 0.036), and this remained significant after adjustment for metastatic status and in the age-stratified sensitivity model, while metastatic disease was associated with progressively higher mortality. Radiotherapy plus chemotherapy and surgery plus chemotherapy were independently associated with lower mortality after multivariable adjustment (HR: 0.48, 95% CI: 0.28-0.85, p = 0.011; HR: 0.45, 95% CI: 0.21-0.94, p = 0.035, respectively). Age, sex, and histological type were not significantly associated with OS.

CONCLUSION: EC demonstrated a substantial mortality burden and poor OS in this population-based cohort. Metastatic status was the strongest associated prognostic factor, while tumor site and treatment modality were associated with survival on Kaplan-Meier analysis. Radiotherapy plus chemotherapy and surgery plus chemotherapy remained independently associated with lower mortality after multivariable adjustment. These findings highlight the importance of early diagnosis, accurate assessment of disease extent, and appropriate multimodal management of EC.