NCCN Guidelines Insights: Esophageal and Esophagogastric Junction Cancers, Version 4.2026: Featured Updates to the NCCN Guidelines
Cet article présente une mise à jour des recommandations du "National Comprehensive Cancer Network" concernant la prise en charge thérapeutique des cancers de l'oesophage ou de la jonction oesogastrique
Upper gastrointestinal tract cancers originating in the esophagus or esophagogastric junction (EGJ) constitute a major global health problem.1,2 Esophageal cancer is the eleventh most frequently diagnosed cancer and the seventh leading cause of cancer-related death in the world.3 The highest-incidence area for esophageal squamous cell carcinoma (ESCC), known as the “esophageal cancer belt,” spans from northern Iran through Central Asia and into Northern China,4,5 although other high-incidence areas include Southern and Eastern Africa and Northern Europe.1,6 Although still relatively rare in the United States, the overall incidence rates for esophageal and EGJ cancers have increased and the 5-year survival rate remains low.7 Screening programs for early detection are not in use or practical because of the low incidence of the disease, and diagnosis is often made late in the disease course. In 2026, an estimated 22,530 people will be diagnosed with esophageal cancer, and 16,290 are expected to die from the disease in the United States.7
Esophageal cancers are histologically classified as squamous cell carcinoma or adenocarcinoma (EAC), which differ in their etiology, pathology, tumor location, therapeutics, and prognosis.8 This article focuses on ESCC, which localizes at or higher than the tracheal bifurcation. ESCC also has a proclivity for early lymphatic spread and is associated with a poor prognosis in advanced stages.8,9 Tobacco and alcohol consumption are the major risk factors for ESCC.10 Associations have been reported between diet and ESCC risk,11,12 but evidence for other risk factors in ESCC is limited (eg, microbiome, nutrient deficiency, molecular alterations).11,13
For patients with advanced ESCC, the treatment landscape has evolved, and targeted therapies and immunotherapies have produced encouraging results. Although this is true for both EAC and ESCC, these NCCN Guidelines Insights highlight current first-line treatment recommendations for unresectable locally advanced, recurrent, or metastatic ESCC, with a focus on immunotherapy, and associated biomarker testing in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Esophageal and Esophagogastric Junction Cancers.
Journal of the National Comprehensive Cancer Network , article en libre accès, 2026