Sex differences in tumor characteristics, treatment, and outcomes of gastric and esophageal cancer surgery: nationwide cohort data from the Dutch Upper GI Cancer Audit

Marianne C. Kalff*, Anna D. Wagner, the Dutch Upper GI Cancer Audit group, Rob H.A. Verhoeven, Valery E.P.P. Lemmens, Hanneke W.M. van Laarhoven, Suzanne S. Gisbertz, Mark I. van Berge Henegouwen

*Corresponding author for this work

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Abstract

Background: Sex differences in clinicopathological characteristics, treatment, and postoperative outcomes of gastric and esophageal cancer are largely undefined. This study aimed to compare tumor and treatment characteristics and outcomes of gastric and esophageal cancer surgery between male and female patients. Methods: Patients after elective surgery for primary esophageal (EAC) or gastric adenocarcinoma (GAC) registered in the Dutch Upper GI Cancer Audit between 2011 and 2016 were included. The primary endpoint, 5-year relative survival with relative excess risk (RER), i.e., adjusted for the normal life expectancy, was compared between male and female patients with EAC and GAC. Results: In total, 4937 patients were included (75% male) with a mean age of 66 years. cT and cN-stages showed a similar distribution in male and female patients. In females, antrum GAC was more frequent (47% vs. 38%, p < 0.001). Female patients with EAC less frequently received neo-adjuvant treatment (OR = 0.60, 95% CI 0.38–0.96, p = 0.033). For GAC, less postoperative morbidity (33% vs. 38% p = 0.017) and less re-interventions (12% vs. 16%, p = 0.008) were observed in females, although they had inferior 5-year relative survival (49% vs. 56%, RER = 1.31, 95% CI 1.09–1.58, p = 0.004). No differences in relative survival of EAC were observed. Conclusions: In addition to significant sex differences in tumor location, female patients with esophageal adenocarcinoma less frequently received neo-adjuvant therapy, and female patients with gastric adenocarcinoma had inferior relative survival. Further consideration and exploration of sex differences in surgical treatment and outcomes are necessary to improve tailored treatment and outcomes.

Original languageEnglish
Pages (from-to)22-32
Number of pages11
JournalGastric Cancer
Volume25
Issue number1
Early online date7 Aug 2021
DOIs
Publication statusPublished - Jan 2022

Bibliographical note

Funding Information:
Wagner has received consulting fees from BMS, Servier Suisse, Merck, MSD, Bayer, EMD Serono, Lilly, Celgene, Shire, and Pfizer, non-financial support (for congress participations) from Sanofi, Astra-Zeneca, AbbVIE, and Ipsen, and an educational grant from Roche to EORTC. Verhoeven has received unrestricted research grants from BMS and Roche. Van Laarhoven has served as a consultant for BMS, Celgene, Lilly, Merck, Nordic, and Servier, and has received unrestricted research funding from Bayer, BMS, Celgene, Lilly, Merck Serono, MSD, Nordic, Philips, Roche, and Servier. Van Berge Henegouwen reports research grants from Olympus and Stryker, in addition to consulting fees from Medtronic, Mylan, and Johnson and Johnson. Lemmens has received unrestricted research grants and educational grants from Roche. The remaining authors have no conflict of interest to report.

Publisher Copyright:
© 2021, The Author(s).

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