Geographical differences in cancer treatment and survival for patients with oesophageal and gastro‐oesophageal junctional cancers

Background Only around one‐quarter of patients with cancer of the oesophagus and the gastro‐oesophageal junction (GOJ) undergo surgical resection. This population‐based study investigated the rates of treatment with curative intent and resection, and their association with survival. Methods Patients diagnosed with oesophageal and GOJ cancer between 2006 and 2015 in Sweden were identified from the National Register for Oesophageal and Gastric Cancer (NREV). The NREV was cross‐linked with several national registries to obtain information on additional exposures. The annual proportion of patients undergoing treatment with curative intent and surgical resection in each county was calculated, and the counties divided into groups with low, intermediate and high rates. Treatment with curative intent was defined as definitive chemoradiation therapy or surgery, with or without neoadjuvant oncological treatment. Overall survival was analysed using a multilevel model based on county of residence at the time of diagnosis. Results Some 5959 patients were included, of whom 1503 (25·2 per cent) underwent surgery. Median overall survival after diagnosis was 7·7, 8·8 and 11·1 months respectively in counties with low, intermediate and high rates of treatment with curative intent. Corresponding survival times for the surgical resection groups were 7·4, 9·3 and 11·0 months. In the multivariable analysis, a higher rate of treatment with curative intent (time ratio 1·17, 95 per cent c.i. 1·05 to 1·30; P  < 0·001) and a higher resection rate (time ratio 1·24, 1·12 to 1·37; P  < 0·001) were associated with improved survival after adjustment for relevant confounders. Conclusion Patients diagnosed in counties with higher rates of treatment with curative intent and higher rates of surgery had better survival.