Long-Term Survival and Treatment Patterns in Resectable Escc in East Asia: A Comprehensive Study From the International Esodata-Study-Group (Dragon Study)

Background Esophageal cancer (EC) has high incidence and mortality rates, particularly in East Asia, including China, Japan, and Korea, where approximately 90% of esophageal cancers are classified as esophageal squamous cell carcinoma (ESCC). This study aims to establish a subproject within a comprehensive esophageal cancer database, focusing on a multidimensional, large-sample, retrospective cohort study. Methods We gathered cases of esophageal cancer treated at Sichuan Cancer Hospital & Institute (SCCH), National Cancer Center Hospital (NCCH), Shanghai Chest Hospital (SHC), The University of Hong Kong (HKU), and Samsung Medical Center (SMC) between 2017 and 2022. Clinical, pathological, treatment, and follow-up prognostic data were compiled for analysis. Results A total of 2482 patients from five participating centers were included in this analysis, with a median follow-up time of 36.5 months (range: 21.49–51.93 months). The R0 resection rate was 95.4% (2368/2482). The 1-, 3-, and 5-year overall survival (OS) rates were 90.7%, 75.3%, and 64.7%, respectively, while the 1-, 3-, and 5-year disease-free survival (DFS) rates were 89.9%, 77.2%, and 71.1%, respectively. Neoadjuvant therapy significantly improved overall survival compared to direct surgery (5-year OS: 70.8% vs. 59.2%, P < 0.001). Conclusion In high-volume centers in East Asia, although neoadjuvant therapy, including neoadjuvant chemotherapy and chemoradiotherapy, is commonly used, the combination of neoadjuvant therapy and surgery is an effective strategy to improve ESCC outcomes. This approach has yielded satisfactory results in high-volume centers. The analysis further confirms that high-volume centers generate higher-quality data, and collaborative research based on these data will significantly contribute to the ISDE Esodata and future updates of the esophageal cancer TNM staging system.