Clinical Features and Prognosis of Cervical Esophageal Cancer

<b>Background:</b> This study aimed to analyze the clinical features and prognosis of cervical esophageal squamous cell carcinoma (ESCC) compared to ESCC more inferiorly in the esophagus. <b>Methods:</b> Medical records of patients with ESCC between December 2008 and December 2024 were retrospectively reviewed. A total of 497 patients with ESCC were included and divided into cervical (n = 32) and non-cervical (n = 465) groups. Clinical features and survival according to treatment were compared between the two groups. <b>Results:</b> Patients with cervical ESCC were older (median age 73 years vs. 67 years, <i>p</i> = 0.047) with a higher proportion of females (18.7% vs. 10.1%, <i>p</i> = 0.133) than patients with non-cervical ESCC. Cervical ESCC had worse differentiation (34.4% vs. 19.6%, <i>p</i> = 0.049 in the rate of poorly differentiated carcinoma) and higher T stage (6.2% vs. 37.2%, <i>p</i> = 0.003 in T1; 28.1% vs. 4.7%, <i>p</i> < 0.001 in T4) than non-cervical ESCC. There was no difference in lymph node metastasis (65.6% vs. 54.6%, <i>p</i> = 0.229) or distant metastasis (15.6% vs. 15.5%, <i>p</i> = 0.983) between the two groups. Overall survival was lower in the cervical group (hazard ratio [HR], 1.51; 95% confidence interval [CI], 0.96-2.40; <i>p</i> = 0.076). When comparing outcomes of patients who underwent definitive chemoradiotherapy, the complete response rate (63.6% vs. 53.4%, <i>p</i> = 0.340) and survival (HR, 1.01; 95% CI, 0.51-1.99; <i>p</i> = 0.973) were similar between the two groups. <b>Conclusions:</b> Although cervical ESCC had a poor prognosis due to its higher T-stage and worse differentiation compared to other locations, outcomes were similar when treated with definitive chemoradiotherapy.