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. 2022 Mar 7;28(9):933-947.
doi: 10.3748/wjg.v28.i9.933.

Sex-based differences in histology, staging, and prognosis among 2983 gastric cancer surgery patients

Yonghoon Choi  1 , Nayoung Kim  1 , Ki Wook Kim  1 , Hyeong Ho Jo  1 , Jaehyung Park  1 , Hyuk Yoon  1 , Cheol Min Shin  1 , Young Soo Park  1 , Dong Ho Lee  1 , Hyeon Jeong Oh  2 , Hye Seung Lee  3 , Young Suk Park  4 , Sang-Hoon Ahn  4 , Yun-Suhk Suh  4 , Do Joong Park  5 , Hyung-Ho Kim  4 , Ji-Won Kim  1 , Jin Won Kim  1 , Keun-Wook Lee  1 , Won Chang  6 , Ji Hoon Park  6 , Yoon Jin Lee  6 , Kyoung Ho Lee  6 , Young Hoon Kim  6
Affiliations

Sex-based differences in histology, staging, and prognosis among 2983 gastric cancer surgery patients

Yonghoon Choi et al. World J Gastroenterol. .

Abstract

Background: Few studies have been conducted on sex differences in the incidence, pathophysiology, and prognosis of gastric cancer (GC).

Aim: To analyze the differences in GC characteristics according to sex in patients who underwent surgical treatment for GC.

Methods: A total of 2983 patients diagnosed with gastric adenocarcinoma who received surgical treatment at the Seoul National University Bundang Hospital between 2003 and 2017 were included. Baseline clinicopathological characteristics, histologic type of GC, overall and GC-specific survival rates, and associated risk factors were analyzed.

Results: Among the 2983 patients, 2005 (67.2%) and 978 (32.8%) were males and females, respectively. The average age of the female group (59.36 years) was significantly younger than that of the male group (61.66 years; P < 0.001). Cancer of the gastric body (P < 0.001) and diffuse-type histology (P < 0.001) were more common in females than in males. This trend was more prominent in females younger than 60 years of age, with a significantly higher proportion of diffuse-type cancer than in the male group. Regardless of sex, diffuse-type GC was more common in younger patients, and the proportion of intestinal-type GC increased with age. The overall survival rate was significantly higher in females (P < 0.001). However, this difference disappeared for GC-specific survival (P = 0.168), except for the poor GC-specific survival rate in advanced-stage cancer (stage III or above) in females (P = 0.045). The risk factors for GC-related mortality were older age, upper location of GC, and diffuse- or mixed-type histology. In terms of comorbidities, more males died from diseases other than GC, including other malignancies such as lung cancer, hepatocellular carcinoma, and pancreatic cancer, and respiratory diseases such as interstitial lung disease and chronic obstructive pulmonary disease, while there were relatively more cardiovascular or cerebrovascular deaths in females.

Conclusion: Sex-based differences in GC were observed in clinicopathological features, including age at diagnosis, tumor location, histologic type, survival rate, and comorbidities.

Keywords: Gastric cancer; Histology; Prognosis; Sex difference; Survival.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Study flow chart of patient enrollment and exclusion process. GC: Gastric cancer.
Figure 2
Figure 2
Proportion of histological types of gastric cancer according to sex and age. The trend of an increasing proportion of intestinal-type cancers with increasing age was observed in both males and females. In males, the proportion of intestinal-type cancer increased steeply from an age of 50 years. In females, the proportion of diffuse-type cancer remained high until 60 years of age. The ratio of intestinal- and diffuse-type gastric cancer in females became similar to that of male patients aged 70 years or older, about 20 years after menopause.
Figure 3
Figure 3
Survival according to sex and initial cancer stage. (A) Overall and (B) gastric cancer–specific survival. A statistically significant female predominance in overall survival was identified (P < 0.001), while a non-significant male predominance was identified in gastric cancer-specific survival. P values were calculated using the log-rank test.
Figure 4
Figure 4
Gastric cancer-specific survival in (A) stage I, (B) stage II, and (C) stage above III. There were no significant differences between males and females in stages I and II, but a statistically significant male predominance was observed in advanced-stage cancer (stage III or above, P = 0.045). P values were calculated using the log-rank test.
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