Largest study of its kind reveals women have superior response to esophageal cancer treatment

August 22, 2017

Female patients with locally advanced esophageal cancer that is treated with chemotherapy and radiation therapy before surgery are more likely to have a favorable response to the treatment than male patients are, and women are less likely to experience cancer recurrence, according to a study published online today in The Annals of Thoracic Surgery.

"Esophageal cancer is one of the deadliest cancers in the world," said senior author K. Robert Shen, MD, of the Mayo Clinic in Rochester, MN. "It affects men and women differently. Men are more at risk to develop this cancer, and it appears that women respond better to the treatments."

Esophageal cancer is four times more common in men than in women, according to the American Cancer Society (ACS). The ACS estimates that there will be about 16,940 (13,360 men and 3,580 women) new cases diagnosed in 2017, with approximately 15,690 deaths (12,720 men and 2,970 women). The lifetime risk to develop esophageal cancer is 1 in 125 for men and 1 in 454 for women.

Dr. Shen and colleagues from the Mayo Clinic analyzed data from all with locally advanced esophageal cancer who underwent chemotherapy and radiation prior to surgery between 1990 and 2013 at all three Mayo Clinic sites (Rochester, MN, Scottsdale, AZ, and Jacksonville, FL). A comparison group of were identified based on matching criteria such as age, pretreatment clinical stage, histologic type, and surgical era. Only patients staged preoperatively with computed tomographic scans and endoscopic ultrasonography were included.

The final cohort included 366 patients (145 women, 221 men). The median age for female patients was 64 years and 61 years for male patients. They had two primary types of esophageal cancer—adenocarcinoma (cancer originating in gland cells/lower part of the esophagus), found in 105 (72 percent) women and 192 (87 percent) men, and squamous cell carcinoma (cancer starting in cells that line the esophagus), diagnosed in 40 (28 percent) women and 29 (13 percent) men.

"We believe our study represents the largest group of female patients ever studied specifically to analyze the impact of gender on response to treatment and long-term outcomes," said Dr. Shen. "It is also the only one to use a methodology where female and male patients were matched based on certain characteristics to eliminate possible confounding factors."

The study showed that either complete or near complete pathologic response occurred in 84 women (58 percent) vs. 103 men (47 percent). In addition, tumor recurrences occurred in 116 (32 percent) patients (38 female, 69 male), resulting in men having an 80 percent increased risk of recurrence. There also was a trend toward superior 5-year survival for vs. men (52.1 percent vs. 44.0 percent), but this did not reach statistical significance.

"The results of this study are intriguing because they suggest that by focusing on individualized and targeted approaches to esophageal cancer treatment, we may be more successful in improving outcomes for future ," said Dr. Shen.

In fact, Dr. Shen explained that the research group recognizes that most cancers affect individuals in different ways, which reflects possible variations in the biology and genetics of the tumor. This remains an active area of research at the Mayo Clinic.

"If the genetic or molecular basis that explains our findings can be elucidated, one can conceive of chemoradiation therapy regimens that are more targeted based on the genetic signatures of each patient's tumors," said Dr. Shen. "An individualized approach to treatment will likely lead to the greatest gains in the treatment of many cancers."

Explore further: Treatment improved overall survival in elderly patients with early-stage esophageal cancer

More information: Phillip G. Rowse et al. Sex Disparities After Induction Chemoradiotherapy and Esophagogastrectomy for Esophageal Cancer, The Annals of Thoracic Surgery (2017). DOI: 10.1016/j.athoracsur.2017.05.030

Related Stories

Treatment improved overall survival in elderly patients with early-stage esophageal cancer

April 27, 2017
Elderly patients with early-stage esophageal cancer that received treatment had an increased 5-year overall survival when compared to patients who received observation with no treatment.

Less-invasive option as effective as esophagus removal in early esophageal cancer

November 7, 2013
Use of a minimally invasive endoscopic procedure to remove superficial, early stage esophageal cancer is as effective as surgery that takes out and rebuilds the esophagus, according to a study by researchers at Mayo Clinic ...

Statins may lower esophageal cancer risk

June 6, 2013
(HealthDay)—Statins may lower the risk of esophageal cancer, particularly in patients with Barrett's esophagus, according to a review published in the June issue of Clinical Gastroenterology and Hepatology.

Risks of esophagus cancer studied: Statins may protect against esophageal cancer

October 22, 2012
Statin use is associated with protection from esophagus cancer according to a new meta-analysis of existing clinical studies exploring the cancer prevention effects of statins presented by a Mayo Clinic researcher, Dr. Siddharth ...

ASCO: VTE is risk factor for recurrence in esophageal cancer

January 19, 2016
(HealthDay)—For patients with esophageal cancer, venous thromboembolism (VTE) is a risk factor for recurrence, according to a study presented at the American Society of Clinical Oncology's annual Gastrointestinal Cancers ...

Recommended for you

Big Data shows how cancer interacts with its surroundings

October 23, 2017
By combining data from sources that at first seemed to be incompatible, UC San Francisco researchers have identified a molecular signature in tissue adjacent to tumors in eight of the most common cancers that suggests they ...

Symptom burden may increase hospital length of stay, readmission risk in advanced cancer

October 23, 2017
Hospitalized patients with advanced cancer who report more intense and numerous physical and psychological symptoms appear to be at risk for longer hospital stays and unplanned hospital readmissions. The report from a Massachusetts ...

CAR-T immunotherapy may help blood cancer patients who don't respond to standard treatments

October 20, 2017
Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis is one of the first centers nationwide to offer a new immunotherapy that targets certain blood cancers. Newly approved ...

Researchers pinpoint causes for spike in breast cancer genetic testing

October 20, 2017
A sharp rise in the number of women seeking BRCA genetic testing to evaluate their risk of developing breast cancer was driven by multiple factors, including celebrity endorsement, according to researchers at the University ...

Study shows how nerves drive prostate cancer

October 19, 2017
In a study in today's issue of Science, researchers at Albert Einstein College of Medicine, part of Montefiore Medicine, report that certain nerves sustain prostate cancer growth by triggering a switch that causes tumor vessels ...

Gene circuit switches on inside cancer cells, triggers immune attack

October 19, 2017
Researchers at MIT have developed a synthetic gene circuit that triggers the body's immune system to attack cancers when it detects signs of the disease.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.