Comprehensive registry of esophageal cancer in Japan, 2014

Abstract

Background

The registration committee for esophageal cancer in the Japan Esophageal Society (JES) has collected the patients' characteristics, treatment, and outcomes annually.

Methods

We analyzed the data of patients who had visited the participating hospitals in 2014. We collected the data with a web-based data collection system using the National Clinical Database. We used the Japanese Classification of Esophageal Cancer 10th edition by JES and the TNM classification 7th edition by the Union of International Cancer Control (UICC) for cancer staging.

Results

A total of 9026 cases were registered from 344 institutions in Japan. Squamous cell carcinoma and adenocarcinoma accounted for 87.9% and 7.1%, respectively. The 5-year survival rates of patients treated using endoscopic resection, concurrent chemoradiotherapy, radiotherapy alone, and esophagectomy were 87.1%, 33.7%, 25.3%, and 59.3%, respectively. Esophagectomy was performed in 5204 cases. Concerning the approach used for esophagectomy, 48.1% of the cases were treated thoracoscopically. The operative mortality (within 30 days after surgery) was 0.75%, and the hospital mortality was 2.0%. The survival curves showed an excellent discriminatory ability both in the clinical and pathologic stages by the JES system. The survival of pStage IV was better than IIIC in the UICC system, because pStage IV included the patients with supraclavicular lymph-node metastasis (M1 LYM).

Conclusion

We hope that this report contributes to improving all aspects of diagnosing and treating esophageal cancer in Japan.

Preface 2014

We sincerely appreciate the outstanding contributions of many physicians in the registry of esophageal cancer cases. The Comprehensive Registry of Esophageal Cancer in Japan, 2014 was published here. Since 2019, the data collection method was changed from an electronic submission to a web-based data collection using the National Clinical Database (NCD). Personal information was replaced with individual management code inside each institute, and the NCD collected only anonymized information. The registry complies with the Act for the Protection of Personal Information.

We briefly summarized the Comprehensive Registry of Esophageal Cancer in Japan, 2014. According to the subject year, the Japanese Classification of Esophageal Cancer 10th by the Japan Esophageal Society (JES) [1] and the Union of International Cancer Control (UICC) TNM Classification 7th [2] were used for cancer staging. A total of 9026 cases were registered from 344 institutions in Japan. Tumor locations were cervical in 4.8%, upper thoracic in 12.9%, middle thoracic in 46.5%, lower thoracic in 27.2%, and esophagogastric junction in 7.8%. Superficial carcinomas (Tis, T1a, T1b) were 37.2%. As for the histologic type of biopsy specimens, squamous cell carcinoma and adenocarcinoma accounted for 87.9% and 7.1%, respectively. Regarding clinical results, the 5-year survival rates of patients treated using endoscopic resection, concurrent chemoradiotherapy, radiotherapy alone, and esophagectomy were 87.1%, 33.7%, 25.3%, and 59.3%, respectively. The endoscopic submucosal dissection accounted for 92.6% of endoscopic resection. Esophagectomy was performed in 5204 cases. Concerning the approach used for esophagectomy, 48.1% of the cases were treated thoracoscopically. The operative mortality (within 30 days after surgery) was 0.75%, and the hospital mortality was 2.0%. The Kaplan–Meier survival curves diverged according to the N-grade both in the JES and the UICC classifications. The survival curves showed an excellent discriminatory ability both in the clinical and pathologic stages by the JES system. In contrast, in the UICC system, the survival of cStage IIB was better than those of IB and IIA, while the survival curves were almost identical between cStage IIIc and IV. Also, the survival curve of pStage IIB was better than that of IIA, and the survival of pStage IV was better than that of IIIC. pStage IV in the UICC system included the patients with supraclavicular lymph-node metastasis (M1 LYM), which is probably the reason for the better prognosis of pStage IV than pStage IIIC.

We hope that this Comprehensive Registry of Esophageal Cancer in Japan 2014 will help to improve all aspects of the diagnosis and treatment of esophageal cancer in Japan.

Contents

I. Clinical factors of esophageal cancer patients treated in 2014

1. Institution-registered cases in 2014

2. Patient background

Table 1 Age and gender

Table 1 Age and gender

Table 2 Performed treatment

Table 2 Performed treatment

Table 3 Tumor location

Table 3 Tumor location

Table 4 Histologic types of biopsy specimens

Table 4 Histologic type of biopsy specimens

Table 5 Depth of tumor invasion, cT (UICC TNM 7th)

Table 5 Depth of tumor invasion, cT (UICC TNM 7th)

Table 6 Lymph-node metastasis, cN (UICC TNM 7th)

Table 6 Lymph-node metastasis, cN (UICC TNM 7th)

Table 7 Distant metastasis, cM (UICC TNM 7th)

Table 7 Distant metastasis, cM (UICC TNM 7th)

Table 8 Clinical stage (UICC TNM 7th)

Table 8 Clinical Stage (UICC TNM 7th)

II. Results of endoscopically treated patients in 2014

Table 9 Details of endoscopic treatment for curative intent

Table 9 Details of endoscopic treatment for curative intent

Table 10 Complications of EMR/ESD

Table 10 Complications of EMR/ESD

Table 11 Pathologic depth of tumor invasion of EMR/ESD specimens

Table 11 Pathologic depth of tumor invasion of MER/ESD specimens

Figure 1 Survival of patients treated with EMR/ESD

Fig. 1

Survival of patients treated with EMR/ESD

Figure 2 Survival of patients treated with EM/ESD according to the pathological depth of tumor invasion, pT (JES 10th)

Fig. 2

Survival of patients treated with EM/ESD according to the pathological depth of tumor invasion, pT (JES 10th)

Figure 3 Survival of patients treated with EMR/ESD according to the lymphatic and venous invasion

Fig. 3

Survival of patients treated with EMR/ESD according to the lymphatic and venous invasion

III. Results in patients treated with chemotherapy and/or radiotherapy in 2014

Table 12 Dose of irradiation (non-surgically treated cases)

Table 12 Dose of irradiation (non-surgically treated cases)

Table 13 Dose of irradiation (surgically treated cases)

Table 13 Dose of irradiation (surgically treated cases)

Figure 4 Survival of patients treated with chemotherapy and/or radiotherapy

Fig. 4

Survival of patients treated with chemotherapy and/or radiotherapy

Figure 5 Survival of patients treated with definitive chemoradiotherapy according to the clinical stage (UICC TNM 7th)

Fig. 5

Survival of patients treated with definitive chemoradiotherapy according to the clinical stage (UICC TNM 7th)

Figure 6 Survival of patients underwent radiotherapy alone according to the clinical stage ( UICC TNM 7th)

Fig. 6

Survival of patients who underwent radiotherapy alone according to the clinical stage (UICC TNM 7th)

IV. Results in patients who underwent esophagectomy in 2014

Table 14 Treatment modalities of esophagectomy

Table 14 Treatment modalities of esophagectomy

Table 15 Tumor location

Table 15 Tumor location

Table 16 Approaches to tumor resection

Table 16 Approaches to tumor resection

Table 17 Video-assisted surgery

Table 17 Video-assisted surgery

Table 18 Fields of lymph-node dissection according to the location of the tumor

Table 18 Fields of lymph-node dissection according to the location of tumor

Table 19 Reconstruction route

Table 19 Reconstruction route

Table 20 Organs used for reconstruction

Table 20 Organs used for reconstruction

Table 21 Histological classification

Table 21 Histological classification

Table 22 Depth of tumor invasion, pT (JES 10th)

Table 22 Pathological depth of tumor invasion, pT (JES 10th)

Table 23 Pathological grading of lymph-node metastasis, pN (JES 10th)

Table 23 Pathological grading of lymph-node metastasis, pN (JES 10th)

Table 24 Pathological findings of lymph-node metastasis, pN (UICC TNM 7th)

Table 24 Pathological grading of lymph-node metastasis, pN (UICC TNM 7th)

Table 25 Pathological findings of distant organ metastasis, pM (JES 10th)

Table 25 Pathological findings of distant organ metastasis, pM (JES 10th)

Table 26 Residual tumor

Table 26 Residual tumor

Figure 7 Survival of patients who underwent esophagectomy

Fig. 7

Survival of patients who underwent esophagectomy

Figure 8 Survival of patients who underwent esophagectomy according to the clinical stage (JES 10th)

Fig. 8

Survival of patients who underwent esophagectomy according to the clinical stage (JES 10th)

Figure 9 Survival of patients who underwent esophagectomy according to the clinical stage (UICC TNM 7th)

Fig. 9

Survival of patients who underwent esophagectomy according to the clinical stage (UICC TNM 7th)

Figure 10 Survival of patients who underwent esophagectomy according to the depth of tumor invasion, pT (JES 10th)

Fig. 10

Survival of patients who underwent esophagectomy according to the depth of tumor invasion, pT (JES 10th)

Figure 11 Survival of patients who underwent esophagectomy according to lymph node metastasis (JES 10th)

Fig. 11

Survival of patients who underwent esophagectomy according to lymph-node metastasis (JES 10th)

Figure 12 Survival of patients who underwent esophagectomy according to lymph node metastasis (UICC TNM 7th)

Fig. 12

Survival of patients who underwent esophagectomy according to lymph-node metastasis (UICC TNM 7th)

Figure 13 Survival of patients who underwent esophagectomy according to the pathological stage (JES 10th)

Fig. 13

Survival of patients who underwent esophagectomy according to the pathological stage (JES 10th)

Figure 14 Survival of patients who underwent esophagectomy according to the pathological stage (UICC TNM 7th)

Fig. 14

Survival of patients who underwent esophagectomy according to the pathological stage (UICC TNM 7th)

Figure 15 Survival of patients who underwent esophagectomy according to the residual tumor (R)

Fig. 15

Survival of patients

I. Clinical features of esophageal cancer patients treated in 2014

Institution-registered cases in 2014.

Institutions
Ageo Central General Hospital
Aichi Cancer Center
Aichi Medical University Hospital
Aizawa Hospital
Akita University Hospital
Arao Municipal Hospital
Asahi Rousai Hospital
Asahikawa Medical University Hospital
Cancer Institute Hospital of JFCR
Chiba Cancer Center
Chiba University Hospital
Chiba-ken Saiseikai Narashino Hospital
Dokkyo Medical University Hospital
Dokkyo Medical University Saitama Medical Center
Edogawa Hospital
Ehime Prefectural Central Hospital
Eijyu General Hospital
Fuchu Hospital
Fuji City General Hospital
Fujinomiya City General Hospital
Fujioka General Hospital
Fujisaki Hospital
Fujita Health University Hospital
Fukaya Red Cross Hospital
Fukui University Hospital
Fukui-ken Saiseikai Hospital
Fukuoka City Hospital
Fukuoka Shin Mizumaki Hospital
Fukuoka University Chikushi Hospital
Fukuoka University Hospital
Fukushima Medical University Hospital
Fukuyama City Hospital
Fussa Hospital
Gifu Prefectural General Center
Gifu University Hospital
Gunma Prefectural Cancer Center
Gunma Saiseikai Maebashi Hospital
Gunma University Hospital
Hachinohe City Hospital
Hagi City Hospital
Hakodate City Hospital
Hakodate Goryokaku Hospital
Hakodate National Hospital
Hamamatsu University Hospital
Hannan Chuo Hospital
Hasuda Hospital
Heartlife Hospital
Higashiosaka City Medical Center
Hiraka General Hospital
Hiratsuka City Hospital
Hirosaki University Hospital
Hiroshima City Asa Hospital
Hiroshima City Hospital
Hiroshima Prefectural Hospital
Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital
Hiroshima University Hospital
Hitachi General Hospital
Hofu Institute of Gastroenterology
Hokkaido University Hospital
Hospital of the University of Occupational and Environmental Health, Japan
Hyogo Cancer Center
Hyogo Prefectural Amagasaki General Medical Center
Hyogo Prefectural Nishinomiya Hospital
Ibaraki Prefectural Central Hospital
Iizuka Hospital
Ikeda City Hospital
Imari Arita Kyoritsu Hospital
International University of Health and Welfare Atami Hospital
International University of Health and Welfare Hospital
International University of Health and Welfare Mita Hospital
Isehara Kyodo Hospital
Iseikai Hospital
Ishikawa Prefectural Central Hospital
Itami City Hospital
Iwata City Hospital
Iwate Medical University Hospital
Iwate Prefectural Central Hospital
Iwate Prefectural Chubu Hospital
JA Hiroshima General Hospital
JA Kouseiren Enshu Hospital
JA Onomichi General Hospital
Japanese Red Cross Ashikaga Hospital
Japanese Red Cross Fukuoka Hospital
Japanese Red Cross Ishinomaki Hospital
Japanese Red Cross Kitami Hospital
Japanese Red Cross Kyoto Daiichi Hospital
Japanese Red Cross Maebashi Hospital
Japanese Red Cross Medical Center
Japanese Red Cross Musashino Hospital
Japanese Red Cross Nagoya Daiichi Hospital
Japanese Red Cross Nagoya Daini Hospital
Japanese Red Cross Saitama Hospital
Japanese Red Cross Tottori Hospital
Japanese Red Cross Wakayama Medical Center
Japanese Red Cross Yamaguchi Hospital
JCHO Gunma Chuo Hospital
JCHO Kyushu Hospital
JCHO Osaka Hospital
JCHO Saitama Medical Center
Jichi Medical University Hospital
Jichi Medical University Saitama Medical Center
Juntendo University Hospital
Juntendo University Nerima Hospital
Juntendo University Shizuoka Hospital
Juntendo University Urayasu Hospital
Junwakai Memorial Hospital
Kagawa Prefectural Central Hospital
Kagawa Rosai Hospital
Kagawa University Hospital
Kagoshima City Hospital
Kagoshima University Hospital
Kakogawa Central City Hospital
Kanagawa Cancer Center
Kanagawa Prefectural Ashigarakami Hospital
Kanazawa Medical University Hospital
Kanazawa University Hospital
Kansai Denryoku Hospital
Kansai Medical University Hospital
Kansai Medical University Medical Center
Kansai Rosai Hospital
Kashiwa Kousei General Hospital
Kasugai Municipal Hospital
Kawakita General Hospital
Kawasaki Medical School Hospital
Kawasaki Medical School Kawasaki Hospital
Kawasaki Municipal Hospital
Kawasaki Municipal Ida Hospital
Kawasaki Saiwai Hospital
Keio University Hospital
Keiyukai Sapporo Hospital
Kindai University Hospital
Kindai University Nara Hospital
Kinki Central Hospital
Kiryu Kousei General Hospital
Kishiwada City Hospital
Kitaakita Municipal Hospital
Kitaharima Medical Center
Kitakyushu Municipal Medical Center
Kitano Hospital
Kitasato University Hospital
Kobe City Medical Center General Hospital
Kobe University Hospital
Kochi Health Science Center
Kochi University Hospital
Kokura Memorial Hospital
Kosei Hospital
Kouseiren Takaoka Hospital
Kumagai General Hospital
Kumamoto University Hospital
Kumamoto Regional Medical Center
Kurashiki Central Hospital
Kurume University Hospital
Kyonan Medical Center Fujikawa Hospital
Kyorin University Hospital
Kyoto University Hospital
Kyoto-Katsura Hospital
Kyushu Central Hospital
Kyushu University Hospital
Machida Municipal Hospital
Matsudo City General Hospital
Matsushita Memorial Hospital
Matsuyama Red Cross Hospital
Mie University Hospital
Minamiosaka Hospital
Minoh City Hospital
Mito Red Cross Hospital
Mitsui Memorial Hospital
Miyazaki University Hospital
Moriguchi Keijinkai Hospital
Nagahama City Hospital
Nagahama Red Cross Hospital
Nagano Municipal Hospital
Nagaoka Chuo General Hospital
Nagasaki University Hospital
Nagoya City University Hospital
Nagoya City West Medical Center
Nagoya Tokushukai General Hospital
Nagoya University Hospital
Nanpuh Hospital
Nara City Hospital
Nara Medical University Hospital
Nasu Red Cross Hospital
National Cancer Center Hospital
National Cancer Center Hospital East
National Center for Global Health and Medicine
National Defence Medical College Hospital
Nerima Hikarigaoka Hospital
New Tokyo Hospital
NHO Beppu Medical Center
NHO Chiba Medical Center
NHO Iwakuni Clinical Center
NHO Kure Medical Center
NHO Kyoto Medical Center
NHO Kyushu Cancer Center
NHO Kyushu Medical Center
NHO Matsumoto Medical Center
NHO Mito Medical Center
NHO Miyakonojo Medical Center
NHO Nagasaki Medical Center
NHO Nagoya Medical Center
NHO Okayama Medical Center
NHO Osaka Medical Center
NHO Saga Hospital
NHO Saitama Hospital
NHO Sendai Medical Center
NHO Shikoku Cancer Center
NHO Takasaki General Medical Center
NHO Tokyo Medical Center
NHO Yokohama Medical Center
Nihonkai General Hospital
Niigata Cancer Center Hospital
Niigata City General Hospital
Niigata Prefectural Shibata Hospital
Niigata University Medical & Dental Hospital
Nikko Memorial Hospital
Nippon Medical School Chiba Hokusou Hospital
Nippon Medical School Hospital
Nippon Medical School Musashi Kosugi Hospital
Nippon Medical School Tama Nagayama Hospital
Nishi Kobe Medical Center
Northern Okinawa Medical Center
NTT Medical Center Tokyo
Numazu City Hospital
Obihiro Kousei Hospital
Ogaki Municipal Hospital
Ogikubo Hospital
Ogori Daiichi General Hospital
Ohta Hospital
Ohta Nishinouchi Hospital
Oita Prefectural Hospital
Oita Red Cross Hospital
Oita University Hospital
Okayama City Hospital
Okayama Red Cross General Hospital
Okayama Saiseikai General Hospital
Okayama University Hospital
Okitama Public General Hospital
Onomichi Municipal Hospital
Osaka City General Hospital
Osaka City University Hospital
Osaka General Medical Center
Osaka International Cancer Institute
Osaka Medical College Hospital
Osaka Police Hospital
Osaka Red Cross Hospital
Osaka University Hospital
Osaki City Hospital
Otemae Hospital
Otsu City Hospital
Rinku General Medical Center
Saga Prefectural Hospital Koseikan
Saga University Hospital
Saiseikai Fukuoka General Hospital
Saiseikai Karatsu Hospital
Saiseikai Kyoto Hospital
Saiseikai Noe Hospital
Saiseikai Utsunomiya Hospital
Saiseikai Yamaguchi General Hospital
Saiseikai Yokohama Tobu Hospital
Saitama Medical University International Medical Center
Saitama Medical University Saitama Medical Center
Sakai City Medical Center
Saku Central Hospital
Sapporo Medical University Hospital
Seikei-kai Chiba Medical Center
Seirei Hamamatsu General Hospital
Sendai City Hospital
Sendai Kosei Hospital
Shiga General Hospital
Shiga University of Medical Science Hospital
Shimane University Hospital
Shin Takeo Hospital
Shinko Hospital
Shinshu University Hospital
Shizuoka Cancer Center
Shizuoka City Shizuoka Hospital
Shizuoka General Hospital
Showa University Hospital
Southern Tohoku General Hospital
St. Luke's International Hospital
St. Marianna University School of Medicine Hospital
St. Mary's Hospital
Steel Memorial Yawata Hospital
Suita Municipal Hospital
Tachikawa Hospital
Tagawa Municipal Hospital
Takatsuki Red Cross Hospital
Teikyo University Chiba Medical Center
Teikyo University Hospital
Teikyo University Hospital Mizonokuchi
Teine Keijinkai Hospital
Tenri Hospital
The Hospital of Hyogo College of Medicine
The Jikei University Daisan Hospital
The Jikei University Hospital
Tochigi Cancer Center
Toda Central General Hospital
Toho University Ohashi Medical Center
Toho University Omori Medical Center
Toho University Sakura Medical Center
Tohoku University Hospital
Tokai University Hachioji Hospital
Tokai University Hospital
Tokai University Tokyo Hospital
Tokushima Red Cross Hospital
Tokushima University Hospital
Tokyo Dental College Ichikawa General Hospital
Tokyo Medical and Dental University Hospital
Tokyo Medical University Hachioji Medical Center
Tokyo Medical University Hospital
Tokyo Medical University Ibaraki Medical Center
Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
Tokyo Metropolitan Tama Medical Center
Tokyo University Hospital
Tokyo Women's Medical University Hospital
Tokyo Women's Medical University Medical Center East
Tokyo Women's Medical University Yachiyo Medical Center
Tonan Hospital
Toshima Hospital
Tottori Prefectural Central Hospital
Tottori University Hospital
Toyama Prefectural Central Hospital
Toyama University Hospital
Toyonaka Municipal Hospital
Toyota Kosei Hospital
Toyota Memorial Hospital
Tsuchiura Kyodo Hospital
Tsukuba University Hospital
Tsuruoka Municipal Shonal Hospital
University Hospital, Kyoto Prefectural University of Medicine
University of the Ryukyus Hospital
Wakayama Medical University Hospital
Yamagata Prefectural Central Hospital
Yamagata University Hospital
Yamaguchi University Hospital
Yamanashi Prefectural Central Hospital
Yamanashi University Hospital
Yao Municipal Hospital
Yokkaichi Hospital
Yokohama City Municipal Hospital
Yokohama City University Hospital
Yokohama City University Medical Center
Yonezawa City Hospital
Yuai Memorial Hospital

(Total 344 institutions)

Patient background

Tables 1, 2, 3, 4, 5, 6, 7, 8.

I. Results of endoscopically treated patients in 2014

Tables 9, 10, 11, and Figs. 1, 2, 3.

II. Results in patients treated with chemotherapy and/or radiotherapy in 2014

Tables 12, 13 and Figs. 4, 5, 6.

III. Results in patients who underwent esophagectomy in 2014

Tables 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, and Figs. 7, 8, 9, 10, 11, 12, 13, 14, 15

Table 27 Cause of death

Follow-up period (months)
Median (min.–max.)	55.29 (0.07–78.78)