OBJECTIVEThe survival time of untreated advanced esophageal squamous cell carcinoma is about 8 - 9 months. The objective of this study was to observe the natural progression of untreated early esophageal squamous cell carcinoma for 20 years.

METHODS4800 subjects from a high risk area of esophageal cancer in Lin-zhou city, Henan province, were examined by endoscopy from 1985 to 1990. Among them, 132 cases were diagnosed as early esophageal cancer. Based on the criteria, the lesions were endoscopically diagnosed as superficial mucosal lesions and histopathologically confirmed by biopsy as carcinoma in situ, intramucosal carcinoma or squamous cell carcinoma. 48 of the 132 patients, who refused treatment, were followed up to the end of 2005. There were 43 death and 5 alive. 40 patients were re-examined for 1 - 4 times by endoscopy during the following up.

RESULTSA total of 48 patients have been followed up for 20 years. 38 (79.2%) cases died of esophageal squamous cell carcinoma, 5 (10.4%) died of non-cancer diseases and 5 (10.4%) were surviving. 37 patients had survived for over 5 years. The 5-, 10-, 15- and 20-years survival rates were 77.1%, 39.6%, 25.0% and 10.4%, respectively.

CONCLUSIONThe natural history of esophageal squamous cell carcinoma takes a long time to progress from early to advanced stage. It is very helpful for early diagnosis and selection of opportunity for treatment. The leading time bias by natural history of this disease should be considered when evaluate therapeutic effect on early stage esophageal cancer.