Original article

Background: Esophageal cancer is common in Pakistan. An attempt has been made for the first time to look
at the survival data and prognostic factors associated with esophageal cancer in this region.
Patients and methods: We did a retrospective review of 263 cases seen at the Aga Khan University Hospital
in Karachi. Data analysis was done using the Kaplan–Meier method and the Cox proportional hazard model.
Results: Squamous cell carcinoma was noted in 81% of the cases, whereas adenocarcinoma was the second
most common. At the time of diagnosis, early-stage disease was found in 25%, locally advanced in 41% and
metastatic in 34% of all cases. Mean age at diagnosis was 56 years, with 59% males and 41% females. Survival
data were available in 89 cases. Median survival was 7 months. On univariate analysis, the following factors
were of prognostic significance: obstruction, histology, albumin level at diagnosis, age and platelet count. On
multivariate analysis, three factors were found prognostic: presence or absence of obstruction, squamous cell
carcinoma versus adenocarcinoma and platelet count.
Conclusions: We found that patients with squamous cell carcinoma and absence of thrombocytopenia and
obstruction had a better overall survival. However, this is a limited retrospective analysis; we therefore recommend
that these prognostic factors be evaluated in larger studies.
Key words: histology, obstruction, prognostic factors, survival, thrombocytopenia

© 2004 European Society for Medical Oncology
*Correspondence to: Dr A. Alidina, Hematology and Oncology, The Aga
Khan University, Stadium Road, PO Box 3500, Karachi 78400, Pakistan.
Tel: +92-21-4930051; Fax: +92-21-4934292;
E-mail: amyn.alidina@aku.edu
Introduction
Esophageal cancer is one of the 10 most common cancers and the
sixth most common cause of cancer deaths worldwide. It is the
third most common gastrointestinal malignancy after gastric,
colorectal and hepatocellular cancers. Esophageal cancer displays
unique epidemiological features that distinguish it from other
malignancies. It shows marked geographical variation, with
exceptionally high rates (some of the world’s highest for any
cancer) ranging from 3 per 100 000 per year reported in Western
countries to 140 per 100 000 reported in Central Asia [1–3]. The
malignancy is relatively more common in Pakistan, being the
seventh most common cancer in men and the sixth most common
in females in Karachi [4]. Data from Karachi show the predominant
histology to be squamous cell carcinoma [5] as opposed to adenocarcinoma,
which is the more common variety in the West. There
have not been any studies in this region on the survival statistics
and prognostic factors of esophageal cancers.
Esophageal cancer is one of the most virulent tumors with a
dismal prognosis, despite the recent advances in early diagnosis
and treatment. It has one of the lowest possibilities of cure, with a
5-year survival rate of approximately 10%; these rates are second
only to hepatobiliary and pancreatic cancers [6]. Given this and
the fact that the incidence of esophageal cancer is on the rise, further
details of this malignancy are required, especially squamous cell
carcinoma.
Patients and methods
A retrospective review of all the 263 cases seen at the Aga Khan University
Hospital, a tertiary-care hospital in Karachi, from 1 January 1995 to 30 June
2002 was done. International Classification of Disease-10 was used for
coding. Data were analyzed using SPSS (Release 10.05, standard version,
copyright ©SPSS; 1989–99). Descriptive analysis was done for demographic,
clinical and radiographic features. Results were expressed as means ± standard
deviation and percentage. The probability curves for survival were calculated
according to the Kaplan–Meier Method and compared by the log-rank test.
Multivariate analysis was carried out using the Cox proportional hazard
model. P <0.05 was considered as statistically significant.
In this study we looked at the following parameters: signs and symptoms,
risk factors, laboratory data, imaging modalities, histology, status of the
disease, overall survival and various prognostic factors of the disease.
Results
Out of the 263 cases reviewed, a male preponderance was
observed (59% males versus 41% females). The mean age at
the time of diagnosis was 56 years. Median age was 60 years
(range 22–85). See Figure 1 for age distribution.
Dysphagia was the most frequently encountered symptom at the
time of presentation, seen in 97% of the cases. Obstruction, seen