Worldwide trends in esophageal cancer survival,by sub-site,morphology,and sex:an analysis of 696,974 adults diagnosed in 60 countries during 2000-2014(CONCORD-3)

Background Esophageal cancer survival is poor worldwide,though there is some variation.Differences in the distribution of anatomical sub-site and morphological sub-type may help explain international differences in survival for all esophageal cancers combined.We estimated survival by anatomic sub-site and morphological sub-type to understand further the impact of topography and morphology on international comparisons of esophageal cancer survival.Methods We estimated age-standardized one-year and five-year net survival among adults(15-99 years)diagnosed with esophageal cancer in each of 60 participating countries to monitor survival trends by calendar period of diagnosis(2000-2004,2005-2009,2010-2014),sub-site,morphology,and sex.Results For adults diagnosed during 2010-2014,tumors in the lower third of the esophagus were the most common,followed by tumors of overlapping sub-site and sub-site not otherwise specified.The proportion of squamous cell carcinomas diagnosed during 2010-2014 was generally higher in Asian countries(50%-90%),while adenocarcinomas were more common in Europe,North America and Oceania(50%-60%).From 2000-2004 to 2010-2014,the proportion of squamous cell carcinoma generally decreased,and the proportion of adenocarcinoma increased.Over time,there were few improvements in age-standardized five-year survival for each sub-site.Age-standardized one-year survival was highest in Japan for both squamous cell carcinoma(67.7%)and adenocarcinoma(69.0%),ranging between 20%-60%in most other countries.Age-standardized five-year survival from squamous cell carcinoma and adenocarcinoma was similar for most countries included,around 15%-20%for adults diagnosed during 2010-2014,though international variation was wider for squamous cell carcinoma.In most countries,survival for both squamous cell carcinoma and adenocarcinoma increased by less than 5%between 2000-2004 and 2010-2014.Conclusions Esophageal cancer survival remains poor in many countries.The distributions of sub-site and morphological sub-type vary between countries,but these differences do not fully explain international variation in esophageal cancer survival.