Oesophageal cancer standing in Morocco from diagnosis to treatments

In Morocco, esophageal cancer (EC) is eight of the most common types of cancer and a leading cause of cancer-related deaths. Incidence and mortality rates in Morocco are higher than the global average, with a higher incidence rate among men than women. Unfortunately, whereas the accessibility of treatment is still limited, the majority of them die before the beginning of treatments or during it. For that, we sought to showcase the Moroccan standing and dealing with EC patients by describing the characteristics, the independent prognostic factors related to death, and treatments accessibility from surgery, chemotherapy, radiotherapy, and targeted therapies, in order to provide insights and the latest data.

Between 2012 to 2019, 264 patients have received histological confirmation of EC as a primary malignancy tumor, of them 129 have been declared locally advanced or metastatic at diagnosis, and therefore have been oriented to adjuvant, neoadjuvant, palliative care, or supportive care depending on performance status (OMS) score, and other parameters, including age at diagnosis; sex; tabaco status; comorbidities (endocrine, cardiac); development site (cervical, thoracic, and abdomen); histology types (adenocarcinoma, epidermoid carcinoma, and small cell carcinoma); tumor aspects (Ulcerative-Budding and Stenosing, Stenosing, Ulcero-infiltrative, Infiltrative, Ulcero-Budding, Budding, and a not precise appearance); tumor invasion (Subcarinar lymphadenomegaly, Mediastinal lymphadenopathy, Jugulo-Carotid lymphadenopathy, Perigastric lymphadenopathy, contact with descending aorta, Para-laryngeal); performance status; pathological T, N, M stages; stage at diagnosis; metastatic sites including (lung, liver, bone, and adrenal); symptoms at diagnosis (Dysphagia, Dyspnea, Vomiting, Epigastric, and General condition impairment); surgery; radiotherapy; chemotherapy (5-FU, Folfox, Xelox, Xeloda, Cisplatin, Docetaxel, and Paclitaxel); hemoglobin level; albumin; CA19-9; ACE. The independent prognostic factors related to survival were picked using Cox Analysis.

The 129 locally advanced and metastatic EC patients who met inclusion and exclusion criteria have been selected for this study. Among these, 50 have experienced the event of interest which is death. The results of multivariate Cox analysis show that age at diagnosis, interval time between biopsy and consultation, tumor site, invasion, histology type, pathological N and M stages, radiotherapy, and chemotherapy were independent prognostic factors related to survival. The median follow-up was 259 [0-1490] days. Meanwhile, the median overall survival was 1290 (95%CI: 521,1490) days. Regarding treatment, only three patients underwent surgery, and most of them received radiotherapy. Moreover, Xeloda and 5-FU were found to be associated with a bad prognosis. Cisplatin was the most favourable treatment with a median survival of 1311 (95%CI: 1290,1490) days, vs 540 days for Xeloda and 77 days for patients who did not receive chemotherapy. The cervical oesophageal part was associated with a good prognosis in addition to adenocarcinoma with a median survival of 1311 and 1007 days respectively. The comparison between the prognostic factors stratification in Kaplan Meier curves shows a signification distinction between subgroups.

Our institution still under the recovery of old standard accepted chemotherapy based medicine, but, comparing to other population, EC patients in Morocco have an acceptable survival rate even with limited accessible treatments.

The authors.

Has not received any funding.

All authors have declared no conflicts of interest.