The Epidemiological Trend of Esophageal Cancer in Mumbai, India, Over the Past Fifteen Years

Background: There has been a definite change in the histopathological spectrum of esophageal cancer towards adenocarcinoma seen in developed countries. In India such studies were limited. Materials and Methods: We retrospectively evaluated patients with histologically proven esophageal cancer who were registered at the Tata Memorial Hospital (Mumbai, India) between 2003 and 2018. The primary aim was to analyze the time-trend of the histological pattern of esophageal cancer. Our secondary objectives included evaluating whether there was any correlation between age, sex, demographics, socioeconomic status, the presence of comorbidities and substance abuse and the histological type of esophageal cancer. Results: Among 7874 patients with esophageal cancer, 5092 (64.7%) were men, with M:F of 2.5:1. The median age was 57 years (IQR, 50-65); Of the 4912 patients in whom a history of tobacco or alcohol use had been elicited, 1360 (27.7%) patients denied substance abuse. Majority of tumor was in middle-third 2942 (41.5%). Squamous cell carcinoma was the histological type in 6413 (81.4%) patients. Multivariate analysis showed that female sex and substance abuse were positively associated with squamous cell carcinoma, while the presence of comorbidities and location of the primary in lower esophagus/GEJ were positively associated with adenocarcinoma. Conclusions: There is no evidence of an epidemiologic shift in the histopathologic spectrum of esophageal cancer in India over last two decades. Four out of five Indian patients with esophageal cancer have squamous cell histology. This is important to recognize, given the varying molecular spectrum and efficacy of therapeutic modalities based on histopathology.