Survival and Factors Associated with Mortality among Esophageal Cancer Patients at A Tertiary Hospital in Northeastern Thailand

Background: Esophageal cancer (EC) is a major global health concern due to its high fatality rate. Although Thailand reports a relatively low incidence, the disease’s prevalence has increased over the past decade. This study aimed to evaluate survival time and identify factors associated with mortality among EC patients. Methods: A hospital-based cohort study was conducted at the tertiary hospital in northeastern, Thailand, including 101 EC patients diagnosed between 2006 and 2015. Subjects were followed for six months. Clinical data were retrospectively collected from medical records and the Cancer Registry. Survival probability was estimated using Kaplan-Meier method, and Cox’s proportional hazards model was applied to identify mortality-associated factors. Results: The median survival time was 4.2 months (95% confidence interval [CI]: 2.97–5.10). The mortality rate was 16.97% (95%CI: 13.10–21.63) per 100 person-months. It revealed that factors: diagnostic procedures, grading, radiotherapy, and surgical therapy were associated with mortality among subjects. Advanced diagnostic procedures increased mortality risk (adjusted hazard ratio [AHR] = 3.04, 95%CI: 1.46–6.33). Conversely, patients with poor or unknown EC differentiation (AHR = 0.33, 95%CI: 0.15–0.71; AHR = 0.11, 95%CI: 0.03–0.38, respectively) and those undergoing surgery or radiotherapy (AHR = 0.43, 95%CI: 0.21–0.87; AHR = 0.35, 95%CI: 0.16–0.78, respectively) had improved survival. Conclusion: While advanced diagnostic procedure correlated with higher mortality, radiotherapy and surgery were linked to improved outcome. The unexpected association between poor tumor differentiation and reduced mortality warrants further investigation. Early detection and timely intervention remain crucial for improving prognosis in EC patients. Keywords: Esophageal cancer, Mortality, Northeastern Thailand, Survival, Tertiary care