University of Oulu

Kauppila, J. H., Wahlin, K. , Lagergren, P. and Lagergren, J. (2019), Sex differences in the prognosis after surgery for esophageal squamous cell carcinoma and adenocarcinoma. Int. J. Cancer, 144: 1284-1291. doi:10.1002/ijc.31840

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

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Author: Kauppila, Joonas H.1,2; Wahlin, Karl1; Lagergren, Pernilla3;
Organizations: 1Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
2Cancer and Translational Medicine Research Unit, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
3Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
4School of Cancer and Pharmaceutical Sciences, King's College London, and Guy's and St Thomas' NHS Foundation Trust, London, UK
Format: article
Version: accepted version
Access: embargoed
Persistent link: http://urn.fi/urn:nbn:fi-fe2019070422784
Language: English
Published: John Wiley & Sons, 2019
Publish Date: 2020-03-15
Description:

Abstract

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.

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Series: International journal of cancer
ISSN: 0020-7136
ISSN-E: 1097-0215
ISSN-L: 0020-7136
Volume: 144
Issue: 6
Pages: 1284 - 1291
DOI: 10.1002/ijc.31840
OADOI: https://oadoi.org/10.1002/ijc.31840
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
3126 Surgery, anesthesiology, intensive care, radiology
Subjects:
sex
Funding: Grant sponsor: Cancerfonden; Grant sponsor: Orionin Tutkimussäätiö; Grant sponsor: Sigrid Juséliuksen Säätiö; Grant sponsor: Vetenskapsrådet
Copyright information: © 2018 UICC. This is the peer reviewed version of the following article: Kauppila, J. H., Wahlin, K. , Lagergren, P. and Lagergren, J. (2019), Sex differences in the prognosis after surgery for esophageal squamous cell carcinoma and adenocarcinoma. Int. J. Cancer, 144: 1284-1291. doi:10.1002/ijc.31840, which has been published in final form at https://doi.org/10.1002/ijc.31840. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.