The impact of smoking on esophageal squamous cell carcinoma

Esophageal cancer (EC) ranks as the eighth most common and sixth deadliest malignancy worldwide, with distinctive geographical distribution patterns. East Asia, particularly China, bears the highest global burden of esophageal squamous cell carcinoma (ESCC), accounting for over half of new cases globally. The high ESCC prevalence in East and Southeast Asia, especially China, likely relates to regional dietary habits, lifestyle factors, and environmental exposures. Smoking, as a widespread lifestyle factor, is recognized as a significant risk factor for multiple cancers, particularly squamous cell carcinomas of the lung and esophagus. The mechanisms of smoking-induced esophageal damage are complex, involving multiple carcinogenic components that cause DNA damage and promote tumor development through inflammatory responses and immunosuppression. Despite public health anti-smoking initiatives showing some success, smoking remains a critical ESCC risk factor. This study aims to systematically review smoking’s impact on ESCC development, progression, and prognosis, analyzing epidemiological patterns, clinical manifestations, prognostic indicators, and underlying mechanisms.