Sex is an Independent Prognostic Factor for Survival in Esophageal Cancer

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(ChemotherapyAdvisor) – Sex is an independent prognostic factor for survival and, compared with men, women age ≥55 years with squamous cell locoregional esophageal cancer and women <55 years of age with squamous cell metastatic esophageal cancer have a significantly better outcome, a study reported in the Journal of Clinical Oncology online May 14.

Data increasingly are suggesting that hormonal influences may account for incidence disparities between men and women with esophageal cancer, noted Heinz-Josef Lenz, MD, of USC/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, and colleagues. They investigated the hypothesis that sex is associated with survival; also explored was whether the relationship between sex and survival depended, at least in part, on age, histology, and race/ethnicity.

A total of 13,603 patients (34%) with metastatic esophageal cancer and 26,848 patients (66%) with locoregional esophageal cancer were identified in SEER databases from 1973 to 2007.

Multivariate analysis found that women had longer esophageal cancer-specific survival than men in both metastatic esophageal cancer (HR, 0.949; P=0.029) and locoregional esophageal cancer cohorts (HR, 0.920; P<0.001).

“When age and histology were accounted for, there was no difference for esophageal cancer-specific survival between men and women with adenocarcinoma,” Dr. Lenz noted. Women <55 years of age (HR, 0.896; P=0.081) and those ≥55 years of age (HR, 0.905; P<0.001) with squamous cell locoregional esophageal cancer had longer esophageal cancer-specific survival than men.

In the squamous cell metastatic esophageal cancer cohort, only women < 55 years of age had longer esophageal cancer-specific survival than men (HR, 0.823; P<0.011).

“In summary, this study shows that sex is an independent prognostic factor regardless of the extent of the disease,” they reported. “Several findings derived from our secondary hypotheses should be confirmed in another independent cohort: the better outcome seen in women with squamous cell metastatic esophageal cancer may be restricted to women younger than age 55 years; women younger than or older than age 55 years with squamous cell locoregional esophageal cancer have a better prognosis, with the latter being statistically significant; sex is not a significant prognostic factor in established esophageal adenocarcinoma. We suggest that these associations are possibly related to both estrogen and androgen exposition,” they concluded.

If validated, future studies that focus on the pathways of sex steroids may help determine the molecular mechanisms linked with poor outcomes, with new treatment approaches designed that can modify pathway activation.

Abstract

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