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. 2021 Nov 2;113(11):1551-1560.
doi: 10.1093/jnci/djab075.

Gender Differences in Treatment Allocation and Survival of Advanced Gastroesophageal Cancer: A Population-Based Study

Willemieke P M Dijksterhuis  1   2 , Marianne C Kalff  3 , Anna D Wagner  4 , Rob H A Verhoeven  1   2 , Valery E P P Lemmens  2   5 , Martijn G H van Oijen  1   2 , Suzanne S Gisbertz  3 , Mark I van Berge Henegouwen  3 , Hanneke W M van Laarhoven  1
Affiliations

Gender Differences in Treatment Allocation and Survival of Advanced Gastroesophageal Cancer: A Population-Based Study

Willemieke P M Dijksterhuis et al. J Natl Cancer Inst. .

Abstract

Background: Biological sex and gender have been reported to affect incidence and overall survival (OS) of curatively treated gastroesophageal cancer. The aim of this study was to compare palliative treatment allocation and OS between women and men with advanced gastroesophageal cancer.

Methods: Patients with an unresectable or metastatic esophageal (including cardia) adenocarcinoma (EAC) or squamous cell carcinoma (ESCC) or gastric adenocarcinoma (GAC) diagnosed in 2015-2018 were identified in the Netherlands Cancer Registry. Treatment allocation was compared using χ2 tests and multivariable logistic regression analyses, and OS using the Kaplan-Meier method with log-rank test and Cox proportional hazards analysis. All statistical tests were 2-sided.

Results: Of patients with EAC (n = 3077), ESCC (n = 794), and GAC (n = 1836), 18.0%, 39.4%, and 39.1% were women, respectively. Women less often received systemic treatment compared with men for EAC (42.7% vs 47.4%, P = .045) and GAC (33.8% vs 38.8%, P = .03) but not for ESCC (33.2% vs 39.5%, P = .07). Women had a lower probability of receiving systemic treatment for GAC in multivariable analyses (odds ratio [OR] = 0.79, 95% confidence interval [CI] = 0.62 to 1.00) but not for EAC (OR = 0.86, 95% CI = 0.69 to 1.06) and ESCC (OR = 0.81, 95% CI = 0.57 to 1.14). Median OS was lower in women with EAC (4.4 vs 5.2 months, P = .04) but did not differ after adjustment for patient and tumor characteristics and systemic treatment administration.

Conclusions: We observed statistically significant and clinically relevant gender differences in systemic treatment administration and OS in advanced gastroesophageal cancer. Causes of these disparities may be sex based (ie, related to tumor biology) as well as gender based (eg, related to differences in treatment choices).

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Figures

Figure 1.
Figure 1.
Flowchart of patient selection. Patients displayed in the blue boxes were included for analyses.
Figure 2.
Figure 2.
Systemic treatment administration (including chemoradiotherapy) stratified for gender and age in patients with esophageal adenocarcinoma (EAC), esophageal squamous cell carcinoma (ESCC), and gastric adenocarcinoma (GAC). Statistically significant differences between men and women are marked with asterisks. The exact number of men and women per age group is listed in Table 2. P values were calculated using a 2-sided χ2 test.
Figure 3.
Figure 3.
Kaplan-Meier curves for overall survival (OS) in patients with esophageal adenocarcinoma (EAC), esophageal squamous cell carcinoma (ESCC), and gastric adenocarcinoma (GAC), stratified for gender. All statistical tests were 2-sided. cM1 = metastatic; cT4b = unresectable.
Figure 4.
Figure 4.
Kaplan-Meier curves for overall survival (OS) in patients with esophageal adenocarcinoma (EAC), esophageal squamous cell carcinoma (ESCC), and gastric adenocarcinoma (GAC) who received systemic treatment (including chemoradiotherapy), stratified for gender. All statistical tests were 2-sided. Age is in years.
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