oesophageal intraepithelial and invasive neoplasia of squamous cell type : epi- demiology and outcome in Luxembourg, 1980-2001

Background and study aims : oesophageal intraepithelial neo- plasia of squamous cell type (INSC) and invasive oesophageal squamous cell carcinoma (IOSCC) are infrequent diseases in Western Europe. The aim of the present study was to collect pop- ulation-based data of both entities over a 20 year-period and to look for concomitant neoplastic affections in order to define an adequate diagnostic strategy. Patients and methods: The National Morphologic Tumour Registry allowed to review the data of all patients with INSC and IOSCC diagnosed between 1980 and 2001 and to record the time trends in incidence, the oncologic co-morbidity and the outcome of the patients. Results : 29 patients with INSC and 363 cases of IOSCC were identified. The overall age-standardized (world) incidence rate of intraepithelial neoplasia and invasive squamous cell carcinoma were 0.2 and 4.2 per 105, respectively, the M/F-ratio for both 3:1. During the study period, the incidence rate of invasive cancer remained stable in males but showed a 3-fold increase in females. There was a 2-fold increase of the intraepithelial neoplasia inci- dence in the last decade. The precancerous/cancerous-ratio increased slightly over the last 5 years. 31% of the patients with an INSC and 17.6% of those with IOSCC had concomitant precan- cerous and cancerous lesions especially of head and neck (laryngo- pharyngeal) or pulmonary origin. The observed 5-year survival rate was 8.8 +/- 3% (95% confidence interval) for IOSCC and 27.6% +/- 17% for INSC. Conclusions : The incidence of invasive oesophageal squamous cell carcinomas remains stable whereas that of detected intraep- ithelial squamous cell neoplasias is remarkably low, indicating potential underdiagnosis. Considering the overall low incidence rates, mass screening for oesophageal cancer does not seem rea- sonable in Luxembourg. Nevertheless, patients at high-risk for oesophageal or head and neck or broncho-pulmonary cancer should be identified and surveilled by endoscopy, possibly with vital staining. (Acta gastroenterol. belg., 2005, 68, 302-307).