Challenges and reflections on the comprehensive management strategy of esophageal cancer in China_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHI Wanzhong ¹ , YANG Zhenyuan ² , CHEN Maohui ² , ZHENG Bin ² ,  ZHANG Shuliang ²

1. Department of Thoracic Surgery, Sanming Second Hospital, Fujian Province, Sanming, 366000, Fujian, P. R. China;
2. Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China;

Corresponding?author：

ZHANG Shuliang, Email: 670627941@qq.com

Keywords：

Esophageal cancer; whole-course management; risk stratification; tiered care; multidisciplinary team; real-world data; quality control

DOI：

10.7507/1007-4848.202603092

Video：

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Esophageal cancer remains a persistently high disease burden and marked disparities across high- and low-incidence regions, urban and rural areas, and different tiers of healthcare institutions in China. Conventional care models centered on isolated interventions, such as surgery, chemoradiotherapy or immunotherapy, are insufficient to systematically address inadequate identification of high-risk populations, low screening adherence, heterogeneous diagnostic staging, inconsistent implementation of multidisciplinary team (MDT) decision-making, and discontinuities in rehabilitation, recurrence surveillance and palliative care after discharge. Based on national screening policies, domestic and international guidelines, randomized controlled trials, systematic reviews/meta-analyses, health-economic studies and real-world evidence from China, this article constructs a China-specific whole-course management pathway for esophageal cancer along the logical chain of "disease burden-baseline management gaps-pathway model-quality indicators-data feedback." The proposed pathway follows the main sequence of risk stratification, tiered screening, precision staging, MDT-based decision-making, standardized treatment, rehabilitation and follow-up, palliative care and data feedback. It defines the responsibilities of primary care facilities, regional centers and national centers, as well as referral triggers, key time targets, quality indicators, criteria for priority high-risk populations, and data dictionary and quality-control requirements for a national disease-specific database. A feasible Chinese model should use county-level electronic registration and endoscopic screening of high-risk populations as entry points, regional MDTs and disease-specific information platforms as hubs, and nutrition/prehabilitation, patient-reported outcomes and real-world data as supporting systems, thereby establishing a replicable, evaluable, reimbursable and sustainable closed-loop management system for esophageal cancer.

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30. Zhu J, Ma S, Chen R, et al. The psychological impact of esophageal cancer screening on anxiety and depression in China. Front Psychiatry, 2022, 13: 933678.
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Latest ArticlesChallenges and reflections on the comprehensive management strategy of esophageal cancer in China

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