A population-based study on gender differences in tumor and treatment characteristics and survival of curable gastroesophageal cancer.

Abstract

4550 Background: Although curative treatment options for gastroesophageal cancer are identical for men and women, outcomes may vary. This study examined differences in tumor and treatment characteristics and survival between men and women with potentially curable gastroesophageal cancer. Methods: Nationwide data was acquired from the Netherlands Cancer Registry. Patients with a potentially curable gastroesophageal carcinoma (cT1-T4a or cTx, any cN, cM0 or cMx) diagnosed between 2006 and 2017 were selected. Patient stratification was performed for tumor location and histology. The primary endpoint, relative survival, was compared between men and women with esophageal adenocarcinoma (EAC), esophageal squamous cell carcinoma (ESCC) and gastric adenocarcinoma (GAC), adjusted for the normal life expectancy for men and women separately. Results: In total, 13,391 patients with an EAC (79.1% men), 5,103 patients with an ESCC (54.7% men), and 8,149 patients with a GAC (60.1% men) were included. Women with gastroesophageal cancer were older than men. Lower cT-stages were observed in women with EAC and ESCC (both p < 0.001) and lower cN-stages were observed in women in all groups, although clinical T- and N-stage were more frequently graded as cTx and cNx in women. In women, EAC tumors were less frequently located in the distal esophagus (70.4% vs. 58.6%, p < 0.001), ESCC tumors had a more proximal tumor location (p < 0.001), and GAC tumors were more frequently located at the antrum (32.3% vs. 37.2%, p < 0.001). For EAC and GAC, but not for ESCC, men were more frequently allocated to a potentially curative treatment; endoscopic resection, surgical resection or definitive chemoradiotherapy (EAC: 74.6% vs. 60.1%, p < 0.001; GAC: 69.0% vs. 65.4%, p 0.001; ESCC: p 0.117). An inferior 5-year relative survival was observed in women with EAC (34.3% vs. 30.1%, p < 0.001) and GAC (36.1% vs. 33.2%, p 0.016). In women with ESCC a superior 5-year relative survival was observed (24.4% vs 28.5%, p 0.001). Conclusions: Remarkable differences in 5-year relative survival were observed between men and women with gastroesophageal cancer, in addition to important differences in tumor stage, tumor location and treatment. Strikingly, men with esophageal and gastric adenocarcinoma were more frequently allocated to a potentially curative treatment compared to women. These findings illustrate the need for further exploration and consideration of gender differences in gastroesophageal cancer treatment.