The influence of prediagnostic demographic and lifestyle factors on esophageal squamous cell carcinoma survival
Aaron P. Thrift
Population Health Department, Queensland Institute of Medical Research, 300 Herston Road, Brisbane, QLD, Australia
School of Population Health, The University of Queensland, Public Health Building, Herston Road, Brisbane, QLD, Australia
Search for more papers by this authorChristina M. Nagle
Population Health Department, Queensland Institute of Medical Research, 300 Herston Road, Brisbane, QLD, Australia
A.P.T. and C.M.N. contributed equally to this work
Search for more papers by this authorPaul P. Fahey
Population Health Department, Queensland Institute of Medical Research, 300 Herston Road, Brisbane, QLD, Australia
Search for more papers by this authorAnne Russell
Population Health Department, Queensland Institute of Medical Research, 300 Herston Road, Brisbane, QLD, Australia
Search for more papers by this authorBernard M. Smithers
Department of Surgery, The University of Queensland, Upper Gastro-intestinal Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
Search for more papers by this authorDavid I. Watson
Department of Surgery, Flinders University, Adelaide, SA, Australia
Search for more papers by this authorCorresponding Author
David C. Whiteman
Population Health Department, Queensland Institute of Medical Research, 300 Herston Road, Brisbane, QLD, Australia
Tel: +61 7 3362 0279, Fax: +61 7 3845 3502
Cancer Control Laboratory, Queensland Institute of Medical Research, Locked Bag 2000 Royal Brisbane Hospital, Queensland 4029, AustraliaSearch for more papers by this authorfor the Australian Cancer Study Clinical Follow-Up Study
Members of the Australian Cancer Study Clinical Follow-Up Study: Investigators: D. C. Whiteman, A. C. Green, D. Gotley, B. M. Smithers, D. I. Watson, G. L. Falk, G. Smith, G. Kiroff, S. Archer, N. K. Hayward, A. Clouston. Project Managers: T. Corish, S. Moore. Database: K. Harrap, T. Sadkowski. Research Nurses: J. Thomas, E. Minehan, D. Roffe, S. O'Keefe, S. Lipshut, G. Connor, H. Berry, L. Terry, M. Connard, L. Bowes, M. R. Malt, J. White. Clinical Contributors: C. Mosse, N. Tait (Australian Capital Territory); C. Bambach, A. Biankan, R. Brancatisano, M. Coleman, M. Cox, S. Deane, J. Gallagher, M. Hollands, T. Hugh, D. Hunt, J. Jorgensen, C. Martin, M. Richardson, R. Smith, D. Storey (New South Wales); J. Avramovic, J. Croese, J. D'Arcy, S. Fairley, J. Hansen, J. Masson, I. Martin, L. Nathanson, B. O'Loughlin, L. Rutherford, R. Turner, M. Windsor (Queensland); J. Bessell, P. Devitt, G. Jamieson (South Australia); S. Blamey, A. Boussioutas, R. Cade, G. Crosthwaite, I. Faragher, J. Gribbin, G. Hebbard, B. Mann, B. Millar, P. O'Brien, R. Thomas, S. Wood (Victoria); K. Faulkner, J. Hamdorf (Western Australia).
Search for more papers by this authorAaron P. Thrift
Population Health Department, Queensland Institute of Medical Research, 300 Herston Road, Brisbane, QLD, Australia
School of Population Health, The University of Queensland, Public Health Building, Herston Road, Brisbane, QLD, Australia
Search for more papers by this authorChristina M. Nagle
Population Health Department, Queensland Institute of Medical Research, 300 Herston Road, Brisbane, QLD, Australia
A.P.T. and C.M.N. contributed equally to this work
Search for more papers by this authorPaul P. Fahey
Population Health Department, Queensland Institute of Medical Research, 300 Herston Road, Brisbane, QLD, Australia
Search for more papers by this authorAnne Russell
Population Health Department, Queensland Institute of Medical Research, 300 Herston Road, Brisbane, QLD, Australia
Search for more papers by this authorBernard M. Smithers
Department of Surgery, The University of Queensland, Upper Gastro-intestinal Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
Search for more papers by this authorDavid I. Watson
Department of Surgery, Flinders University, Adelaide, SA, Australia
Search for more papers by this authorCorresponding Author
David C. Whiteman
Population Health Department, Queensland Institute of Medical Research, 300 Herston Road, Brisbane, QLD, Australia
Tel: +61 7 3362 0279, Fax: +61 7 3845 3502
Cancer Control Laboratory, Queensland Institute of Medical Research, Locked Bag 2000 Royal Brisbane Hospital, Queensland 4029, AustraliaSearch for more papers by this authorfor the Australian Cancer Study Clinical Follow-Up Study
Members of the Australian Cancer Study Clinical Follow-Up Study: Investigators: D. C. Whiteman, A. C. Green, D. Gotley, B. M. Smithers, D. I. Watson, G. L. Falk, G. Smith, G. Kiroff, S. Archer, N. K. Hayward, A. Clouston. Project Managers: T. Corish, S. Moore. Database: K. Harrap, T. Sadkowski. Research Nurses: J. Thomas, E. Minehan, D. Roffe, S. O'Keefe, S. Lipshut, G. Connor, H. Berry, L. Terry, M. Connard, L. Bowes, M. R. Malt, J. White. Clinical Contributors: C. Mosse, N. Tait (Australian Capital Territory); C. Bambach, A. Biankan, R. Brancatisano, M. Coleman, M. Cox, S. Deane, J. Gallagher, M. Hollands, T. Hugh, D. Hunt, J. Jorgensen, C. Martin, M. Richardson, R. Smith, D. Storey (New South Wales); J. Avramovic, J. Croese, J. D'Arcy, S. Fairley, J. Hansen, J. Masson, I. Martin, L. Nathanson, B. O'Loughlin, L. Rutherford, R. Turner, M. Windsor (Queensland); J. Bessell, P. Devitt, G. Jamieson (South Australia); S. Blamey, A. Boussioutas, R. Cade, G. Crosthwaite, I. Faragher, J. Gribbin, G. Hebbard, B. Mann, B. Millar, P. O'Brien, R. Thomas, S. Wood (Victoria); K. Faulkner, J. Hamdorf (Western Australia).
Search for more papers by this authorAbstract
Demographic and lifestyle factors, in particular tobacco smoking and alcohol, are well established causes of esophageal squamous cell carcinoma (ESCC); however, little is known about the effect of these factors on survival. We included all 301 patients with incident ESCC, recruited into a population-based case–control study of esophageal cancer in Australia. Detailed information about demographic and lifestyle factors was obtained at diagnosis, and deaths were identified using the National Death Index. Median follow-up for all-cause mortality was 6.4 years. Hazard ratios (HRs) and 95% confidence intervals (95% CI) were calculated from Cox proportional hazards models, adjusted for age, sex, pretreatment AJCC tumor stage, treatment and presence of comorbidities. Two hundred and thirteen patients (71%) died during follow-up. High lifetime alcohol consumption was independently associated with poor survival. Relative to life-long nondrinkers and those consuming <1 drink/week, the HRs for those with average consumption of 7–20 drinks/week or ≥21 drinks/week were 2.21 (95% CI = 1.27–3.84) and 2.08 (95% CI = 1.18–3.69), respectively. There was a suggestion of worse survival among current smokers (HR = 1.42, 95% CI = 0.89–2.28); however, the risk of early death was greatest among current smokers who reported regularly (≥7 drinks/week) consuming alcohol (HR = 3.84, 95% CI = 2.02–7.32). Other lifestyle factors putatively associated with risk of developing ESCC were not associated with survival. In addition to increasing disease risk, heavy alcohol consumption may be independently associated with worse survival among patients with ESCC. Future clinical follow-up studies should consider alcohol as a potential prognosticator, in addition to known clinicopathologic factors.
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