Oesophago-gastric cancer QPIs survival analyses
Patients diagnosed from 2013 to 2019, and followed up to 31 December 2023

About this release

This report by Public Health Scotland (PHS) is part a series of publications on cancer survival, using data from the Cancer Audit - Quality Performance Indicators (QPIs) dataset. This publication focuses on oesophago-gastric cancer patients diagnosed between 2013 and 2019.

The main purpose of the report is to examine whether survival outcomes were equitable across the three regional cancer networks: North Cancer Alliance (NCA), South East Scotland Cancer Network (SCAN) and West of Scotland Cancer Network (WoSCAN).

Main points

During 2013 to 2019, 9,848 cases of oesophago-gastric cancer were diagnosed and treated in NHS Scotland (approximately 1,400 per year).

For oesophageal adenocarcinoma (4,679 cases):

• Overall survival from all causes of death (including cancer) differed between regional networks, with survival lowest in NCA (5-year survival was 11% in NCA, 15% in SCAN, and 13% in WoSCAN).
• After adjustment for sex, age, deprivation and stage using a statistical model, there remained a difference in all-cause mortality rates between networks, with the relative risk of death estimated to be 14% higher in NCA compared to SCAN (HR 1.14; 95% CI: 1.05–1.24).
• At a more granular level, for stages 1, 2 and 4, there was no difference in overall survival between networks. For stage 3, survival was significantly higher in SCAN, but the effect size was small with little difference in median survival between networks (range 1.1-1.2 years).
• In relation to specific radical treatments (treatments with a curative intent), there was no difference in overall survival between networks for those who received radical surgery or for those who received radical chemoradiotherapy.
• Focussing on all radically treated patients combined: the proportion of patients who received a radical treatment was similar across networks (27% in NCA; 27% in SCAN; 23% in WoSCAN). But for these radically treated patients, survival was lower in NCA compared to the other two networks. This may reflect patient management since proportionally fewer patients in NCA received radical surgery (54%) and proportionally more received chemoradiotherapy (40%), compared to both SCAN (87% and 2%, respectively) and WoSCAN (66% and 20% respectively).
• However, given that recording rates for patient performance status (an index of mobility/frailty) were low and variability in cancer staging is known to be high, it is difficult to assess whether these differences reflect differences in treatment decision-making (similar patients receiving different treatments) or different patient clinical features (variation in presenting patient populations). See independent clinical response for clinical interpretation.
• Focussing on just those that received radical surgery: overall survival in Scotland was higher in 2016-19 than it was in 2013-15, with median survival estimated to be 4.2 years, up from 3.1 years.

For oesophageal squamous cell carcinoma (1,961 cases):

• Overall survival from all causes of death did not differ significantly between networks
  (5-year survival was 11% in NCA, 10% in SCAN and 12% WoSCAN).
• However, network cohorts differed in demographics and patient composition, including in patient performance status, deprivation, and stage distribution.
• After adjustment for sex, age, deprivation and stage using a statistical model, there was a difference in all-cause mortality rates between networks, with the relative risk of death estimated to be 19% higher in SCAN compared to WoSCAN (HR 1.19; 95% CI: 1.06–1.35). This result should be interpreted with caution, since the underlying reasons for this result were not clear and important predictors of patient outcomes such as patient performance status and comorbidities could not be included due to data quality issues.
• There was no evidence for further differences in survival between networks (for treatment-related subpopulations) or for an improvement over time.

Note that there were also 649 cases of oesophageal cancer designated oesophageal 'other'.

Finally, for gastric cancer (2,559 cases), there was no evidence for a difference in survival between networks or for an improvement over time.

Please note that statistical models cannot adjust for all factors that affect survival and differ between regional populations. Hence, it cannot be ruled out that reported differences are due to further demographic confounding, rather than regional health service performance.

An independent clinical response to this publication has been provided alongside these results to aid interpretation and detail actions being undertaken to address issues identified.

Background

This report was initially released to clinicians as Management Information in May 2025.

Data are from the Cancer Audit-QPIs dataset which underpins the National Cancer Quality Programme's quality performance indicators and is collected to support improvement in cancer care. NHS Boards are required to report these indicators against a clinically agreed indicator-specific target as part of the mandatory National Cancer Quality Programme (CEL 06 2012).

Note the data reported are not directly comparable to those reported by the Scottish Cancer Registry in PHS as only patients who receive cancer treatment within NHS Scotland are included in the QPIs dataset, unlike the SCR data which includes all patients diagnosed within Scotland, providing population-based incidence data and survival estimates.

Consequently, the cancer survival figures reported here using QPIs data are not directly comparable to the overall population-based survival statistics routinely reported by PHS.

Publication

Independent clinical response

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