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. 2023 Jul:187:114-123.
doi: 10.1016/j.ejca.2023.04.002. Epub 2023 Apr 8.

Sex differences in treatment allocation and survival of potentially curable gastroesophageal cancer: A population-based study

Marianne C Kalff  1 , Willemieke P M Dijksterhuis  2 , Anna D Wagner  3 , Sabine Oertelt-Prigione  4 , Rob H A Verhoeven  2 , Valery E P P Lemmens  5 , Hanneke W M van Laarhoven  6 , Suzanne S Gisbertz  7 , Mark I van Berge Henegouwen  8
Affiliations
Free article

Sex differences in treatment allocation and survival of potentially curable gastroesophageal cancer: A population-based study

Marianne C Kalff et al. Eur J Cancer. 2023 Jul.
Free article

Abstract

Background: Although curative treatment options are identical for male and female gastroesophageal cancer patients, access to care and survival may vary. This study aimed to compare treatment allocation and survival between male and female patients with potentially curable gastroesophageal cancer.

Methods: Nationwide cohort study including all patients with potentially curable gastroesophageal squamous cell or adenocarcinoma diagnosed between 2006 and 2018 registered in the Netherlands Cancer Registry. The main outcome, treatment allocation, was compared between male and female patients with oesophageal adenocarcinoma (EAC), oesophageal squamous cell carcinoma (ESCC), and gastric adenocarcinoma (GAC). Additionally, 5-year relative survival with relative excess risk (RER), that is, adjusted for the normal life expectancy, was compared.

Results: Among 27,496 patients (68.8% men), most were allocated to curative treatment (62.8%), although rates dropped to 45.6%>70 years. Curative treatment rates were comparable among younger male and female patients (≤70 years) with gastroesophageal adenocarcinoma, while older females with EAC were less frequently allocated to curative treatment than males (OR = 0.85, 95% confidence interval [CI] 0.73-0.99). For those allocated to curative treatment, relative survival was superior for female patients with EAC (RER = 0.88, 95% CI 0.80-0.96) and ESCC (RER = 0.82, 95% CI 0.75-0.91), and comparable for males and females with GAC (RER = 1.02, 95% CI 0.94-1.11).

Conclusions: While curative treatment rates were comparable between younger male and female patients with gastroesophageal adenocarcinoma, treatment disparities were present between older patients. When treated, the survival of females with EAC and ESCC was superior to males. The treatment and survival gaps between male and female patients with gastroesophageal cancer warrant further exploration and could potentially improve treatment strategies and survival.

Keywords: Gastric cancer; Oesophageal cancer; Sex; Surgery; Survival.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Wagner has received consulting fees from BMS, Servier Suisse, Merck, MSD, Bayer, EMD Serono, Lilly, Celgene, Shire, Pierre-Fabre and Pfizer, non-financial support (travel fees) from Sanofi, Astra-Zeneca, AbbVIE and Ipsen and an educational grant from Roche to EORTC. Verhoeven has received unrestricted research grants from BMS and Roche. Van Laarhoven has served as a consultant for BMS, Celgene, Lilly, and Nordic and has received unrestricted research funding from Bayer, BMS, Celgene, Lilly, Merck Serono, MSD, Nordic, Philips, Roche and Servier. Van Berge Henegouwen reports research grants from Stryker, in addition to consulting fees from Medtronic, Mylan BBraun, and Johnson and Johnson. The remaining authors have no conflicts of interest to report.

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