Sacchi D, Fanelli G N, De Marchi D, Zorzi M, Guzzinati S, Rugge M

8th Triennial Congress of Pathological Anatomy Siapec-iap 2019

Turin, 16-18 October  2019




In the last decades, consistently all over the industrialized world, a decreased incidence of esophageal cancer (EC) has been reported (1,2,3). However, data about: i) the prevalence of the most involved esophageal sub-sites; ii) the histological cancer sub-types; iii) the cancer staging; iv) the neoadjuvant therapies and their clinico-pathological effectiveness are fragmentary reported, or completely lacking.
This study is aimed to assess the status of EC registration in the (pathology-based) Cancer Registry of the Veneto Region (Registro Tumori del Veneto [RTV]). The study particularly focused on the current adequacy of the collected clinico-pathological variables as registered by the RTV between years 1987-2015.


The ECs incidence rates were computed using the RTV data, as collected between the years 1987 and 2015 (regional population covered by the RTV in the considered time-interval: 2.475.000). Incidence rates were standardized according to the European standard population 2013.
The study further considered the clinico-biological variables, as collected from a subgroup of subjects (313.668; years: 2000-2015) living in a well-defined Regional area (Verona). The pathology reports of incident ECs were considered. In such a population of EC-patients, the following clinico-pathological variables were checked, as potential indicators of the cancer status at the diagnosis, or of the cancer clinical outcome: i) anatomic site (upper, medium, lower esophagus); ii) surgical intervention (performed versus not performed); iii) cancer stage at the initial diagnosis (pT, pN); iv) Mandard Index of tumor regression.


In the considered regional population (2.475.000 inhabitants; years: 1987 to 2015), the EC incidence rates steadily decreased, with an annual percent change of -3.3% in men and -1.6% in women. The incidence rate in 1987 was 26.2/100,000 in men, and 4.2/100,000 in women, and it dropped to 8.9 and 2.2/100,000 in 2015, respectively. In a subgroup of subjects (69 incident ECs as assessed in a population of 313.668 subjects; years: 2000-2015), the study explored the clinico-pathological cancer information, as available from the collected pathology records. Among this test-population (about 80% were males, and more than 95% of them were older than 60 years old), the cancer sub-site was reported in only 2 cases (2,9%). According to pathology records, only 5 cases (7.2%) underwent surgical intervention. According to clinical and pathological data, T-Stage was available in less than 19% of the cases and the Nodal status in less than 18%. The Mandard Index was available for 5 cases (7,2%), overall.


Till December 31st 2015, the Veneto Cancer Registry covered a population of 2.475.000 regional inhabitants (currently, the covered population accounts for 4.900.000 [100% of the Veneto region population]). This study assessed the status of EC registration in the Regional Cancer Registry between the years 1987-2015. In the considered interval time, the incidence rate of ECs (all the histotypes) significantly decreased from 1987 to 2015. In a small (not representative) sub-group of the covered population, very scanty clinico-pathological information was additionally achievable through consulting the pathology reports of 69 incident ECs (population 313.668 subjects; years: 2000-2015). These unsatisfactory results unequivocally support the priority of consistently expanding the collection/registration of clinical-biological data concerning esophageal cancer patients. The current disappointing situation prompts implementing several procedural improvements: i) to standardize data collection and consistently coding of the considered variables; ii) to chronologically update the cancer data collection/registration; iii) to reconsider critically the clinico-pathological variables to be included in patient-record; iv) to accelerate the nation-wide registration of the oncological disease. These combined implementations will allow an efficient remodulations of the strategic interventions in both cancer (primary and secondary) prevention, and therapies.