Background: Esophageal squamous cell carcinoma (ESCC) is the most common subtype of esophageal cancer (EC) worldwide, with significant geographic variability in its incidence and outcomes. This study aims to analyse the characteristics of Moroccan ESCC patients, identify independent prognostic factors for mortality and assess access to surgery, chemotherapy, radiotherapy (RT) and targeted therapies.

Methods: This retrospective study analysed data from the Marrakesh-Safi regional cancer registry. Between 2014 and 2019, a total of 78 patients were histologically confirmed to have locally advanced or metastatic ESCC. Demographic, clinical and treatment data were evaluated to determine prognostic factors for overall survival (OS) using Kaplan–Meier and multivariate Cox regression analyses.

Results: The median age was 56 years (IQR: 48–66), with a slight female predominance in stage III (59%). Dysphagia was the most frequent symptom (92%), and the thoracic esophagus was the most common tumour site (53%). Performance status was significantly worse in stage IV (31% with PS 4, p < 0.001). Chemotherapy was administered to 72% of patients, with cisplatin being the most used drug. RT was more common in stage III (57% versus 33%, p = 0.035), while surgery was rare (2 cases). Multivariate analysis identified performance status as a key prognostic factor (HR = 27.2, p = 0.015), while RT significantly reduced mortality risk (HR = 0.07, p = 0.038). Stage III patients had a median OS of 46 months, with 1- and 3-year OS rates of 84% and 78%, respectively. In contrast, stage IV patients had a median OS of 8.6 months, with 1-year and 3-year OS rates of 34% and 22%, respectively.

Conclusion: Patients with locally advanced or metastatic EC face poor survival outcomes. RT and performance status are key factors that significantly influence prognosis. These findings underscore the urgent need for early detection, enhanced access to multimodal treatments and improved healthcare infrastructure to improve survival outcomes.