Impact of occupation on survival of esophageal squamous cell carcinoma patients following esophagectomy: a long-term survival analysis

BACKGROUND: Esophageal cancer (EC), particularly esophageal squamous cell carcinoma (ESCC), is a major global health issue with high incidence and mortality rates in Asia. This study examines the impact of occupational background on the long-term survival of ESCC patients following esophagectomy. METHODS: Data were obtained from the Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management Database (SCCH-ECCM Database), focusing on patients with ESCC who underwent esophagectomy between 2010 and 2017. Patients were classified into four occupational groups: Farmer, Civil Servant, Teacher, and Factory Worker. The primary outcome measured was overall survival (OS), which was analyzed using Kaplan-Meier survival curves, Cox proportional hazards models, and restricted mean survival time (RMST). To account for potential confounding factors, propensity score matching (PSM) was employed. RESULTS: Among the cohort, 67.5% were Farmers, 9.0% Civil Servants, 1.9% Teachers, and 21.6% Factory Workers. The median follow-up was 72.2 months, with a median OS of 49.8 months. One-, three-, and five-year OS rates varied slightly by occupation, with Factory Workers displaying the highest one-year survival rate at 91%. Significant survival differences were noted between Farmers and Civil Servants (HR: 1.291; 95% CI: 1.030 - 1.618; P = 0.027),the significance persisted even after PSM (HR: 1.376; 95% CI: 1.004 - 1.885; P = 0.047). Civil Servants, who presented with more advanced disease stages, had the lowest crude RMST, aligning more closely with other groups after adjustment. CONCLUSIONS: The results revealed that ESCC patients categorized as Civil Servants exhibited a poorer prognosis compared to those classified as Farmers.