J Cancer 2017; 8(13):2417-2423. doi:10.7150/jca.19210

Research Paper

Esophageal Cancer in Israel has Unique Clinico-Pathological Features: A Retrospective Study

Michal Sarfaty1, 4✉, Esty Lankry4, Assaf Moore1, Noga Kurman1, Ofer Purim1, 4, Yulia Kundel1, 4, Irit Ben-Aharon1, 4, Gali Perl1, 4, Olga Ulitsky1, Noa Gordon1, Aaron Sulkes1, 4, Nikolai Menasherov2, 4, Hanoch Kashtan3, 4, Baruch Brenner1, 4

1. Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel;
2. Department of Surgery A, Rabin Medical Center, Petach Tikva, Israel;
3. Department of Surgery B, Rabin Medical Center, Petach Tikva, Israel;
4. Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.

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Sarfaty M, Lankry E, Moore A, Kurman N, Purim O, Kundel Y, Ben-Aharon I, Perl G, Ulitsky O, Gordon N, Sulkes A, Menasherov N, Kashtan H, Brenner B. Esophageal Cancer in Israel has Unique Clinico-Pathological Features: A Retrospective Study. J Cancer 2017; 8(13):2417-2423. doi:10.7150/jca.19210. Available from https://www.jcancer.org/v08p2417.htm

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Introduction: Data regarding esophageal cancer (EC) in Israel are limited. The aim of this study was hence to characterize this entity in the Israeli population and to compare it to the literature.

Patients/Methods: This is a retrospective study of all consecutive EC patients treated at our institution between 1997-2013. Data were retrieved from patients' medical files.

Results: Two hundred patients were included. The median age at diagnosis was 70.5 years; 63.5% were males; 63% were Ashkenazi Jews, 29% were Sephardic Jews, and 0.5% were Arabs. Squamous cell carcinoma (SCC) was predominant: 52% versus 45.5% with adenocarcinoma (ADC). SCC was common even in the distal esophagus (45%). The overall 5-year survival rate was 25.5%. A temporal trend (2006-2013 vs 1997-2005) shows a decline in the proportion of SCC (47% vs 63%, p=0.061) and a rise in ADC (50% vs 33%, p=0.041), with a parallel decrease in patients' age (median: 68.5 vs 73 years, p=0.014). In the later period, patients received more treatment for localized and metastatic disease, with a trend for improved median survival (20.1 vs 14.9 months, p=0.658). Ashkenazi Jews were diagnosed at an older age than Sephardic Jews (median: 73 vs. 65 years, p=0.001), had a higher rate of family history of GI cancer (34% vs. 17%, p=0.026) and a higher rate of cardiovascular co-morbidity (41% vs. 24%, p=0.041).

Conclusion: EC in Israel represents an intermediate entity between the Western and the endemic subtypes, showing some unique features. These included delayed reversal of the SCC/ADC ratio, commonness of SCC in the distal esophagus, prevalence of other malignancies and predominance of Ashkenazi ethnicity. The reason for these findings is unclear and its further evaluation is warranted.

Keywords: Esophageal cancer, Squamous, Adenocarcinoma, Israel, Epidemiology