Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 1;14(13):3240.
doi: 10.3390/cancers14133240.

Sex Differences in Neoplastic Progression in Barrett's Esophagus: A Multicenter Prospective Cohort Study

Carlijn A M Roumans  1   2 , Pauline A Zellenrath  1 , Ewout W Steyerberg  2   3 , Iris Lansdorp-Vogelaar  2 , Michael Doukas  4 , Katharina Biermann  4 , Joyce Alderliesten  5 , Gert van Ingen  6 , Wouter B Nagengast  7 , Arend Karrenbeld  8 , Frank Ter Borg  9 , Mariska Hage  10 , Pieter C J Ter Borg  11 , Michael A den Bakker  12   13 , Alaa Alkhalaf  14 , Frank C P Moll  15 , Lieke Brouwer-Hol  16 , Joop van Baarlen  17   18 , Rutger Quispel  19 , Arjan van Tilburg  20 , Jordy P W Burger  21 , Antonie J P van Tilburg  22 , Ariadne H A G Ooms  4   23 , Thjon J Tang  24 , Mariëlle J L Romberg-Camps  25 , Danny Goudkade  26 , Marco J Bruno  1 , Dimitris Rizopoulos  27 , Manon C W Spaander  1
Affiliations

Sex Differences in Neoplastic Progression in Barrett's Esophagus: A Multicenter Prospective Cohort Study

Carlijn A M Roumans et al. Cancers (Basel). .

Abstract

Recommendations in Barrett's esophagus (BE) guidelines are mainly based on male patients. We aimed to evaluate sex differences in BE patients in (1) probability of and (2) time to neoplastic progression, and (3) differences in the stage distribution of neoplasia. We conducted a multicenter prospective cohort study including 868 BE patients. Cox regression modeling and accelerated failure time modeling were used to estimate the sex differences. Neoplastic progression was defined as high-grade dysplasia (HGD) and/or esophageal adenocarcinoma (EAC). Among the 639 (74%) males and 229 females that were included (median follow-up 7.1 years), 61 (7.0%) developed HGD/EAC. Neoplastic progression risk was estimated to be twice as high among males (HR 2.26, 95% CI 1.11-4.62) than females. The risk of HGD was found to be higher in males (HR 3.76, 95% CI 1.33-10.6). Time to HGD/EAC (AR 0.52, 95% CI 0.29-0.95) and HGD (AR 0.40, 95% CI 0.19-0.86) was shorter in males. Females had proportionally more EAC than HGD and tended to have higher stages of neoplasia at diagnosis. In conclusion, both the risk of and time to neoplastic progression were higher in males. However, females were proportionally more often diagnosed with (advanced) EAC. We should strive for improved neoplastic risk stratification per individual BE patient, incorporating sex disparities into new prediction models.

Keywords: Barrett’s esophagus; acceleration rate; neoplastic progression; sex.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Hematoxylin–eosin staining of (A) Barrett’s esophagus (BE) without dysplasia (NDBE); (B) BE with low-grade dysplasia (LGD); (C) BE with high-grade dysplasia (HGD); and (D) esophageal adenocarcinoma (EAC). Original magnifications ×50 [A and D], ×80 [C] and ×100 [B]).
Figure 2
Figure 2
Stage distribution of neoplasia according to sex, with stage 0 including TisN0M0 and HGD, stage 1 including T1N0M0 and T2N0M0, and stage 2 including T3N0M0 and T1/T2N1M0. Data for 5 male patients were missing.
See this image and copyright information in PMC

References

    1. Spechler S.J. Barrett’s esophagus and esophageal adenocarcinoma: Pathogenesis, diagnosis, and therapy. Med. Clin. N. Am. 2002;86:1423–1445. doi: 10.1016/S0025-7125(02)00082-2. - DOI - PubMed
    1. Shaheen N., Ransohoff D.F. Gastroesophageal reflux, barrett esophagus, and esophageal cancer: Scientific review. JAMA. 2002;287:1972–1981. doi: 10.1001/jama.287.15.1972. - DOI - PubMed
    1. Steevens J., Botterweck A.A., Dirx M.J., van den Brandt P.A., Schouten L.J. Trends in incidence of oesophageal and stomach cancer subtypes in Europe. Eur. J. Gastroenterol. Hepatol. 2010;22:669–678. doi: 10.1097/MEG.0b013e32832ca091. - DOI - PubMed
    1. Cook M.B., Chow W.H., Devesa S.S. Oesophageal cancer incidence in the United States by race, sex, and histologic type, 1977–2005. Br. J. Cancer. 2009;101:855–859. doi: 10.1038/sj.bjc.6605246. - DOI - PMC - PubMed
    1. Siegel R., Naishadham D., Jemal A. Cancer statistics, 2013. CA Cancer J. Clin. 2013;63:11–30. doi: 10.3322/caac.21166. - DOI - PubMed