Sex Differences in Neoplastic Progression in Barrett’s Esophagus: A Multicenter Prospective Cohort Study

Carlijn A.M. Roumans, Pauline A. Zellenrath, Ewout W. Steyerberg, Iris Lansdorp-Vogelaar, Michael Doukas, Katharina Biermann, Joyce Alderliesten, Gert van Ingen, Wouter B. Nagengast, Arend Karrenbeld, Frank Ter Borg, Mariska Hage, Pieter C.J. Ter Borg, Michael A. Den Bakker, Alaa Alkhalaf, Frank C.P. Moll, Lieke Brouwer-Hol, Joop van Baarlen, Rutger Quispel, Arjan van TilburgJordy P.W. Burger, Antonie J.P. van Tilburg, Ariadne H.A.G. Ooms, Thjon J. Tang, Mariëlle J.L. Romberg-Camps, Danny Goudkade, Marco J. Bruno, Dimitris Rizopoulos, Manon C.W. Spaander*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Recommendations in Barrett’s esophagus (BE) guidelines are mainly based on male patients. We aimed to evaluate sex differences in BE patients in (1) probability of and (2) time to neoplastic progression, and (3) differences in the stage distribution of neoplasia. We conducted a multicenter prospective cohort study including 868 BE patients. Cox regression modeling and accelerated failure time modeling were used to estimate the sex differences. Neoplastic progression was defined as highgrade dysplasia (HGD) and/or esophageal adenocarcinoma (EAC). Among the 639 (74%) males and 229 females that were included (median follow-up 7.1 years), 61 (7.0%) developed HGD/EAC. Neoplastic progression risk was estimated to be twice as high among males (HR 2.26, 95% CI 1.11–4.62) than females. The risk of HGD was found to be higher in males (HR 3.76, 95% CI 1.33–10.6). Time to HGD/EAC (AR 0.52, 95% CI 0.29–0.95) and HGD (AR 0.40, 95% CI 0.19–0.86) was shorter in males. Females had proportionally more EAC than HGD and tended to have higher stages of neoplasia at diagnosis. In conclusion, both the risk of and time to neoplastic progression were higher in males. However, females were proportionally more often diagnosed with (advanced) EAC. We should strive for improved neoplastic risk stratification per individual BE patient, incorporating sex disparities into new prediction models.

Original languageEnglish
Article number3240
JournalCancers
Volume14
Issue number13
DOIs
Publication statusPublished - 1 Jul 2022

Bibliographical note

Funding Information:
Funding: This study was funded by ZonMw within the grant of Gender and Health, number 79684.

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.

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