(ChemotherapyAdvisor)– Sex is an independent prognostic factor for survivaland, compared with men, women age ≥55 years with squamous cell locoregionalesophageal cancer and women <55 years of age with squamous cell metastaticesophageal cancer have a significantly better outcome, a study reported in the Journal of Clinical Oncology online May14.

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

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

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

“When age and histology were accounted for, there was nodifference for esophageal cancer-specific survival between men and women withadenocarcinoma,” 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 esophagealcancer-specific survival than men.

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

“In summary, this study shows that sex is an independentprognostic factor regardless of the extent of the disease,” they reported. “Severalfindings derived from our secondary hypotheses should be confirmed in another independentcohort: the better outcome seen in women with squamous cell metastaticesophageal cancer may be restricted to women younger than age 55 years; womenyounger than or older than age 55 years with squamous cell locoregionalesophageal 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 andandrogen exposition,” they concluded.

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