Ursodeoxycholic Acid and Long-Term Survival in Primary Biliary Cirrhosis

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Abstract
At the population level, a detailed picture of the nature of adenocarcinoma at the distal esophagus and esophagogastric junction under modern treatment is lacking. We evaluated the fate of these patients and the results of various types of therapeutic procedures using unselected population-based data. Primary data on patients with these adenocarcinomas in two health care districts in Finland were retrieved from the Finnish Cancer Registry. The fate of all 402 patients treated between 1990 and 1998 in 23 units was analyzed. The 5-yr survival rate of these patients was 12.5%. Median survival was 36.5 days (0 days- 68.1 months) with best supportive care (18.9%), 116.5 days (0 days-59.5 months) with palliative (33.8%), mainly either endoscopic or oncological treatment, 211 days (113 days-26.6 months) with exploratory surgery (4.7%), and 17.6 months (0-101.1) after esophageal resection (42.5%). The 5-yr and 8-yr survival rates in this unselected material after esophageal resection including 8.8% operative mortality were 29.0% and 26.0%. The best chance for cure and long-term survival came from esophagectomy with 2-field lymphadenectomy compared to less extensive operations (50.0%vs 23.2% survival at 5 yrs, p= 0.005). Between these groups no statistically significant difference (p= 0.4) existed in pathological TNM stages or in the distribution of node-negative tumors (47.6%vs 41.8%). Although overall prognosis for adenocarcinoma near the esophagogastric junction is poor, a substantial percentage of patients eligible for major surgery achieve long-term survival.