Influence of Sex on the Survival of Patients With Esophageal Cancer

Abstract

A B S T R A C T PurposeThe prognostic value of sex for esophageal cancer survival is currently unclear, and growing data suggest that hormonal influences may account for incidence disparities between men and women. Therefore, moving from the hypothesis that hormones could affect the prognosis of patients with esophageal cancer, we investigated the primary hypothesis that sex is associated with survival and the secondary hypotheses that the relationship between sex and survival depends, at least in part, on age, histology, and race/ethnicity. Patients and MethodsBy using the SEER databases from 1973 to 2007, we identified 13,603 patients (34%) with metastatic esophageal cancer (MEC) and 26,848 patients (66%) with locoregional esophageal cancer (LEC). Cox proportional hazards model for competing risks were used for analyses. ResultsIn the multivariate analysis, women had longer esophageal cancer-specific survival (ECSS) than men in both MEC (hazard ratio [HR], 0.949; 95% CI, 0.905 to 0.995; P ϭ .029) and LEC (HR, 0.920; 95% CI, 0.886 to 0.955; P Ͻ .001) cohorts. When age and histology were accounted for, there was no difference for ECSS between men and women with adenocarcinoma. In contrast, women younger than age 55 years (HR, 0.896; 95% CI, 0.792 to 1.014; P ϭ .081) and those age 55 years or older (HR, 0.905; 95% CI, 0.862 to 0.950; P Ͻ .001) with squamous cell LEC had longer ECSS than men. In the squamous cell MEC cohort, only women younger than age 55 years had longer ECSS (HR, 0.823; 95% CI, 0.708 to 0.957; P ϭ .011) than men. ConclusionSex is an independent prognostic factor for patients with LEC or MEC. As secondary hypotheses, in comparison with men, women age 55 years or older with squamous cell LEC and women younger than age 55 years with squamous cell MEC have a significantly better outcome. These last two findings need further validation.

Factors Potentially Associated with Chemotherapy-induced Anemia in Patients with Solid Cancers

“…We noticed, in our data, that male, aged, cisplatin-containing regimen were associated with each other, and with lung or esophageal carcinomas. The patients with these factors were susceptible to CIA, the interpretation may be multifactorial, for example, the aged has a poor hemocytogenesis, aged male was reported to be more frequent in lung carcinoma (Owonikoko et al, 2007) and esophageal carcinoma (Bohanes et al, 2012), the patients with lung and esophageal carcinomas were received more cisplatin-containing chemotherapy as standard regimen. Platinum-based therapies were well recognized to cause anemia as reported previously (Groopman et al, 1999;Kosmidis et al, 2005;Spivak et al, 2009).…”

The comparison of predictive factors regarding prognoses and invasion of thymic neuroendocrine tumors preoperatively and postoperatively

“…However, in our present study, survival rate and OS duration in female patients were significantly poorer than male patients postoperatively. As mentioned above, female TNT patients had worse prognoses because of the factors that affect survival, such as health attitudes, behaviors, influence of bioactive amines (EN, CRH, ACTH), and response to adjuvant therapies, are different between male and female patients (8,(11)(12)(13)(14). Postoperatively, gender was an independent risk factor for OS.…”

“…Besides, the differences in TNT survival by gender probability, NET in other organs, such as esophagus, colon, thyroid, pancreas, and so on, has revealed carcinoid syndrome more frequently in females than in males, and reports have shown that patients with carcinoid syndrome had significantly shorter OS than those without the condition (8,11). Compared with male patients, females had a high incidence of secretion of CRH, ACTH, estrogen (EN) which could (I) enhance the degree of malignancy and the rate of development of TNT, (II) raise the possibility of females having a lower response to adjuvant chemotherapies (8,(11)(12)(13)(14). These factors probably caused female patients to be diagnosed in a relatively advanced stage than male and also disfavored the effectiveness of traditional adjuvant chemotherapies in the treatment of female patients, thus bringing about relatively worse OS in female than male patients.…”

Oligometastatic Disease in Upper Gastrointestinal Cancer - How to Proceed

“…Since (especially premenopausal) women with metastatic squamous esophageal cancer seem to have a lower risk of dying from esophageal cancer when compared with men of similar age [17] and (especially the postmenopausal) show a statistically better prognosis of locoregional advanced disease [17], the female gender might be one of those prognostic factors supporting a more aggressive treatment of these patients.…”