Sex-based differences in histology, staging, and prognosis among 2983 gastric cancer surgery patients

Abstract

BACKGROUND Few studies have been conducted on sex differences in the incidence, pathophysiology, and prognosis of gastric cancer (GC). AIM To analyze the differences in GC characteristics according to sex in patients who underwent surgical treatment for GC. METHODS A total of 2983 patients diagnosed with gastric adenocarcinoma who received surgical treatment at the Seoul National University Bundang Hospital between 2003 and 2017 were included. Baseline clinicopathological characteristics, histologic type of GC, overall and GC-specific survival rates, and associated risk factors were analyzed. RESULTS Among the 2983 patients, 2005 (67.2%) and 978 (32.8%) were males and females, respectively. The average age of the female group (59.36 years) was significantly younger than that of the male group (61.66 years; P < 0.001). Cancer of the gastric body ( P < 0.001) and diffuse-type histology ( P < 0.001) were more common in females than in males. This trend was more prominent in females younger than 60 years of age, with a significantly higher proportion of diffuse-type cancer than in the male group. Regardless of sex, diffuse-type GC was more common in younger patients, and the proportion of intestinal-type GC increased with age. The overall survival rate was significantly higher in females ( P < 0.001). However, this difference disappeared for GC-specific survival ( P = 0.168), except for the poor GC-specific survival rate in advanced-stage cancer (stage III or above) in females ( P = 0.045). The risk factors for GC-related mortality were older age, upper location of GC, and diffuse- or mixed-type histology. In terms of comorbidities, more males died from diseases other than GC, including other malignancies such as lung cancer, hepatocellular carcinoma, and pancreatic cancer, and respiratory diseases such as interstitial lung disease and chronic obstructive pulmonary disease, while there were relatively more cardiovascular or cerebrovascular deaths in females. CONCLUSION Sex-based differences in GC were observed in clinicopathological features, including age at diagnosis, tumor location, histologic type, survival rate, and comorbidities.

Sex Disparity in Patients with Gastric Cancer: A Systematic Review and Meta-Analysis

“…Female gastric cancer patients had a better prognosis, and this fnding was consistent with most previous studies [9][10][11][12][13][14][15][16][17][18]. Tere are many possible reasons for this phenomenon.…”

“…Figure 2 presents the meta-analysis of the 3-year overall survival (OS) and 5-year OS in the total patient population reviewed. Significant sex-based differences in the OS of the total patient population obtained from the twenty-eight studies reviewed were found [ 9 – 16 , 19 – 24 , 31 , 45 , 55 , 61 , 65 , 69 – 72 , 80 , 81 , 86 , 87 , 89 ]. Our meta-analysis showed that females with gastric cancer were associated with better 3-year OS and 5-year OS relative to males (HR = 0.90, 95% CI: 0.86, 0.95, P = 0.003, I 2 = 53%; HR = 0.86, 95% CI: 0.82, 0.91, P < 0.00001, I 2 = 66%,respectively).…”

“…This meta-analysis was conducted utilizing data from 43 retrospective comparative trails [ 7 , 9 , 12 – 16 , 20 , 24 , 30 , 32 – 39 , 41 , 42 , 45 , 48 – 51 , 53 , 55 , 64 , 66 , 69 – 72 , 74 , 79 – 81 , 84 – 89 ], two prospective studies [ 44 , 83 ], and thirty-one observational studies [ 10 , 11 , 19 , 21 – 23 , 25 , 31 , 40 , 43 , 46 , 47 , 52 , 54 , 56 – 63 , 65 , 67 , 68 , 73 , 75 – 78 , 82 ] with 775,003 gastric cancer patients. The results revealed that the prognosis of female gastric cancer patients was better than that of males for total patients, but there was no significant difference in the Asian patient group.…”

“…Studies on the prognosis of gastric cancer in females have produced mixed results. While in most studies, female patients had a better prognosis [9][10][11][12][13][14][15][16][17][18], several other studies showed no independent sex-related associations with OS [19][20][21][22]. Tough some recent studies have found that females had a better overall prognosis, this was not found to be the case in young female patients [23][24][25].…”

Impact of Body Mass Index on Survival Depending on Sex in 14,688 Patients with Gastric Cancer in a Tertiary Hospital in South Korea

“…Furthermore, diffuse-type GC was more frequent in females (86.4%) than in males (76.6%).These results were also found in previous reports of GC patients receiving surgical treatment, with diffuse-type GC common in young females, and females had a poor prognosis than males in the advanced TNM stage group. 27 However, BMI information was not included in the report. Above all, we highlighted the sex differences in the association between BMI and GC location, treatment modality, TNM stage, and tissue type, that is, a higher proportion of patients with severe obesity (9.3%) was found only in males but not in females (3.6%).…”