Abstract
Esophageal cancer is one of the cancers that seriously threaten the lives and health of patients around the world. Squamous cell carcinoma accounts for a higher proportion of esophageal cancer cases. At the same time, the number of esophageal squamous cell carcinoma (ESCC) patients also has an increasing trend year by year. Therefore, it is important to identify the prognostic factors of ESCC to improve the survival and prognosis of patients. As an important sociodemographic factor, gender has an important influence on the occurrence, development and prognosis of certain diseases. However, it has not been clear from existing studies whether gender affects the prognosis of ESCC patients. The aim of this study was to determine the effect of sex on overall survival (OS) in patients with ESCC. Methods: This study analyzed 6890 patients with ESCC diagnosed from 2007 to 2015 who were identified in the SEER (Surveillance, Epidemiology, and End Results) database. Kaplan-Meier method and Cox Proportional Hazards model were used to conduct survival analysis and regression analysis to evaluate the association between gender and OS. Results: We found that the OS differed with sex in patients with ESCC, with the 5-year OS rate being higher in females (19.2%) than in males (12.9%). A Cox multivariate analysis showed that sex was an independent prognostic factor for ESCC, with the OS being significantly better in female patients than in male patients (P<0.001). Subgroup analyses showed that sex affected the survival rate of patients with American Joint Committee on Cancer tumor, node, and metastasis stages I (P=0.013), II (P<0.001), III (P=0.014), and IV (P<0.001). Conclusion: Our results suggest that the OS of patients with ESCC is significantly better in females than males. Therefore, more attention should be paid to the prognosis of male patients with ESCC, with prospective interventions and health education applied in order to improve their survival outcomes.
Highlights
Esophageal cancer is the sixth most common cause of cancer-related deaths around the world [1]
The prognosis of patients with esophageal squamous cell carcinoma (ESCC) has improved due to advances in radiotherapy, chemotherapy and surgical techniques [7,8,9], the overall 5-year survival rate is still less than 20% [10, 11]
The sex-related difference in survival rate might be related to differences in hormone levels, since estrogen and progesterone in females can reportedly reduce their risk of developing ESCC [23], and overexpression of the androgen receptor is related to the occurrence of ESCC and adenocarcinoma [24]
Summary
Esophageal cancer is the sixth most common cause of cancer-related deaths around the world [1]. The prognosis of patients with esophageal squamous cell carcinoma (ESCC) has improved due to advances in radiotherapy, chemotherapy and surgical techniques [7,8,9], the overall 5-year survival rate is still less than 20% [10, 11]. It is [11] important to identify the prognostic factors for ESCC in order to improve the survival rate of patients and the accuracy of prognoses
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