OBJECTIVE: To improve understanding of sex differences in clinicopathologic characteristics, treatment and outcomes between male and female patients undergoing esophagectomy for esophageal cancer. SUMMARY BACKGROUND DATA: Esophageal cancer is a male predominant disease, and sex has not been considered in previous studies as an important factor in diagnosis or management. Sex differences in demographics, clinicopathologic characteristics, and postoperative outcomes remain largely undefined. METHODS: Retrospective review of 1958 patients (21% female) with esophageal cancer who underwent esophagectomy at a single institution between 1995 and 2017. RESULTS: Most patients had adenocarcinoma (83%); however, the rate of squamous cell carcinoma was significantly higher in females (35% vs 11%, respectively; P < .0001). Females had a lower rate of smoking (62 vs 73%) and heavy alcohol use (12 vs 19%) but a higher rate of previous mediastinal radiation (8.4 vs 1.8%) (P < 0.001). Postoperative mortality and overall survival (OS) were similar between sexes. However, subanalysis of patients with locoregional disease (clinical stage II/III) demonstrated that females received neoadjuvant therapy less frequently than males and had worse OS (median OS 2.56 yrs vs 2.08; P = 0.034). This difference remained significant on adjusted analysis (HR 1.24, 95% CI 1.06-1.46). CONCLUSIONS: Female patients had higher incidence of squamous cell carcinoma despite lower prevalence of behavioral risk factors. Among patients with locoregional disease, undertreatment in females may reflect treatment bias and history of previous mediastinal radiation. Esophageal cancer in females should be considered a unique entity as compared with the presentation and treatment of males.
OBJECTIVE: To improve understanding of sex differences in clinicopathologic characteristics, treatment and outcomes between male and female patients undergoing esophagectomy for esophageal cancer. SUMMARY BACKGROUND DATA: Esophageal cancer is a male predominant disease, and sex has not been considered in previous studies as an important factor in diagnosis or management. Sex differences in demographics, clinicopathologic characteristics, and postoperative outcomes remain largely undefined. METHODS: Retrospective review of 1958 patients (21% female) with esophageal cancer who underwent esophagectomy at a single institution between 1995 and 2017. RESULTS: Most patients had adenocarcinoma (83%); however, the rate of squamous cell carcinoma was significantly higher in females (35% vs 11%, respectively; P < .0001). Females had a lower rate of smoking (62 vs 73%) and heavy alcohol use (12 vs 19%) but a higher rate of previous mediastinal radiation (8.4 vs 1.8%) (P < 0.001). Postoperative mortality and overall survival (OS) were similar between sexes. However, subanalysis of patients with locoregional disease (clinical stage II/III) demonstrated that females received neoadjuvant therapy less frequently than males and had worse OS (median OS 2.56 yrs vs 2.08; P = 0.034). This difference remained significant on adjusted analysis (HR 1.24, 95% CI 1.06-1.46). CONCLUSIONS: Female patients had higher incidence of squamous cell carcinoma despite lower prevalence of behavioral risk factors. Among patients with locoregional disease, undertreatment in females may reflect treatment bias and history of previous mediastinal radiation. Esophageal cancer in females should be considered a unique entity as compared with the presentation and treatment of males.
Authors: Tamar B Nobel; Arianna Barbetta; Meier Hsu; Kay See Tan; Tiffany Pinchinat; Francisco Schlottmann; Manjit S Bains; Geoffrey Y Ku; Abraham J Wu; Marco G Patti; David R Jones; Daniela Molena Journal: J Gastrointest Surg Date: 2018-09-13 Impact factor: 3.452
Authors: Donald E Low; Derek Alderson; Ivan Cecconello; Andrew C Chang; Gail E Darling; Xavier Benoit DʼJourno; S Michael Griffin; Arnulf H Hölscher; Wayne L Hofstetter; Blair A Jobe; Yuko Kitagawa; John C Kucharczuk; Simon Ying Kit Law; Toni E Lerut; Nick Maynard; Manuel Pera; Jeffrey H Peters; C S Pramesh; John V Reynolds; B Mark Smithers; J Jan B van Lanschot Journal: Ann Surg Date: 2015-08 Impact factor: 12.969
Authors: Rachna Raman; Sundeep Deorah; Bradley D McDowell; Taher Abu Hejleh; Charles F Lynch; Amit Gupta Journal: Contemp Oncol (Pozn) Date: 2015-09-28
Authors: Tamar B Nobel; Rebecca A Carr; Raul Caso; Jennifer Livschitz; Samuel Nussenzweig; Meier Hsu; Kay See Tan; Smita Sihag; Prasad S Adusumilli; Matthew J Bott; Robert J Downey; James Huang; James M Isbell; Bernard J Park; Gaetano Rocco; Valerie W Rusch; David R Jones; Daniela Molena Journal: BJS Open Date: 2021-11-09
Authors: Willemieke P M Dijksterhuis; Marianne C Kalff; Anna D Wagner; Rob H A Verhoeven; Valery E P P Lemmens; Martijn G H van Oijen; Suzanne S Gisbertz; Mark I van Berge Henegouwen; Hanneke W M van Laarhoven Journal: J Natl Cancer Inst Date: 2021-11-02 Impact factor: 13.506
Authors: Marianne C Kalff; Anna D Wagner; Rob H A Verhoeven; Valery E P P Lemmens; Hanneke W M van Laarhoven; Suzanne S Gisbertz; Mark I van Berge Henegouwen Journal: Gastric Cancer Date: 2021-08-07 Impact factor: 7.370