Sex differences in the prognosis after surgery for esophageal squamous cell carcinoma and adenocarcinoma

• Published in: International journal of cancer Vol. 144; no. 6; pp. 1284 - 1291
• Main Authors: Kauppila, Joonas H, Wahlin, Karl, Lagergren, Pernilla, Lagergren, Jesper
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 15.03.2019; Wiley Subscription Services, Inc
• Subjects: Adenocarcinoma; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Aged; Cancer; Esophageal cancer; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophageal Squamous Cell Carcinoma - mortality; Esophageal Squamous Cell Carcinoma - pathology; Esophageal Squamous Cell Carcinoma - therapy; Esophagectomy; Esophagus; Esophagus - pathology; Esophagus - surgery; Female; Follow-Up Studies; gender; Gender differences; Health risk assessment; Humans; Male; Medical research; Medicin och hälsovetenskap; Middle Aged; Mortality; Neoadjuvant Therapy - methods; neoplasm; Neoplasm Staging; Prognosis; Registries - statistics & numerical data; Risk Factors; sex; Sex differences; Sex Factors; Squamous cell carcinoma; Surgery; Survival Analysis; Sweden - epidemiology; Treatment Outcome; Sweden; gender; sex; mortality; neoplasm; esophagus; prognosis; surgery
• ISSN: 0020-7136; 1097-0215; 1097-0215
• DOI: 10.1002/ijc.31840

Some investigations suggest a better prognosis in women compared to men with esophageal cancer but these differences are uncertain. The aim of our study was to clarify whether sex influences the prognosis after esophagectomy for esophageal squamous cell carcinoma and esophageal adenocarcinoma. A population‐based and nationwide cohort study included almost all patients who underwent esophagectomy for esophageal cancer in Sweden in 1987–2010, with follow‐up until 2016. Patients’ sex was analyzed in relation to risk of mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for calendar period, age, education, comorbidity, tumor stage, neoadjuvant therapy, and surgeon volume. Among 1,816 participants, 1,024 (56%) had esophageal squamous cell carcinoma (355 [35%] women), and 792 (44%) had esophageal adenocarcinoma (103 [13%] women). Compared to men, women had a decreased overall all‐cause mortality in esophageal squamous cell carcinoma (HR = 0.73, 95% CI 0.63–0.85). Stratified analyses showed decreased mortality limited to women aged >55 years (HR = 0.71, 95% CI 0.61–0.83), but in all tumor stages, particularly stages 0‐I (HR = 0.54, 95% CI 0.37–0.79). Women also had decreased 90‐day all‐cause mortality, 5‐year all‐cause mortality, and 5‐year disease‐specific mortality in esophageal squamous cell carcinoma compared to men. For esophageal adenocarcinoma, no sex differences were found for any of the mortality outcomes. Thus, women who undergo esophagectomy for esophageal squamous cell carcinoma seem to have better prognosis than men, especially those with early tumor stages, whereas no sex differences in prognosis were found for esophageal adenocarcinoma. What's new? While sex differences are suspected of influencing esophageal squamous cell carcinoma, whether sex is associated with the disease remains unclear. In this population‐based cohort study in Sweden, among patients who underwent esophagectomy for esophageal squamous cell carcinoma between 1987 and 2010, women were found to have better prognosis than men. In particular, women exhibited decreased 5‐year all‐cause and 5‐year disease‐specific mortality, with notably lower mortality for women with early‐stage tumors. By comparison, for esophageal adenocarcinoma, no sex differences were found in prognosis. The findings draw attention to potentially important prognostic differences between the sexes specifically for esophageal squamous cell carcinoma.