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Men with esophageal cancer more likely to experience recurrence
Women with locally advanced esophageal cancer who received chemoradiotherapy prior to surgery appeared more likely to achieve complete response and less likely to experience disease recurrence than their male counterparts, according to a frequency-matched nonrandomized retrospective review.
“Esophageal cancer is one of the deadliest cancers in the world. However, since the incidence rate in the Western world is relatively low compared [with] lung and breast cancers, it has not garnered much attention,” K. Robert Shen, MD, cardiothoracic surgeon at Mayo Clinic in Rochester, Minnesota, told HemOnc Today.
Neoadjuvant chemoradiotherapy followed by surgical resection has become the standard of care for locally advanced esophageal carcinoma. However, limited data exist regarding correlations between sex and the ability to achieve a complete response with this treatment regimen.
“Esophageal cancer is four times more common in men than in women,” Shen added. “The lifetime risk to develop esophageal cancer is one in 125 for American men and one in 454 American women.”
The researchers retrospectively reviewed data from 366 patients with locally advanced esophageal carcinoma — including 145 consecutive women (median age, 64 years) and 221 men (median age, 61 years) — who underwent neoadjuvant chemoradiotherapy followed by surgical resection to determine the impact of sex on treatment response, tumor recurrence and survival.
Fewer women than men had adenocarcinoma histologic type (72% vs. 87%), but more women had squamous cell carcinoma (28% vs. 13%; P = .005).
Women more frequently achieved complete pathologic response (30% vs. 25%) and nearly complete pathologic response (28% vs. 20%) to induction therapy than men, whereas fewer women achieved only partial pathologic response (42% vs. 53%). More than half (58%) of women experienced complete or nearly complete pathologic responses compared with only 47% of men (P = .034).
In addition, a greater proportion of women than men achieved 5-year OS (52.1% vs. 44%), although this was not a significant difference.
According to univariate analysis, male sex (HR = 1.76; 95% CI, 1.15-2.68) and partial pathologic response (HR = 2.96; 95% CI, 1.98-4.43) increased risk for recurrence.
Of 341 evaluable patients, 32% experienced recurrence after a median of 292 days.
Men had 80% increased risk for recurrence (HR = 1.8; 95% CI, 1.15-2.68) compared with women.
Forty-seven percent (95% CI, 41.4-53.6) of patients achieved 5-year RFS. Women showed superior RFS (71.7%; 95% CI, 60.8-81.3) compared with men (55.4%; 95% CI, 47.6-63.8; P = .008) after a median follow-up of 4.2 years.
Researchers found no association between sex and risk for death; however, partial responders appeared 2.5 times more likely to die (HR = 2.56; 95% CI, 1.88-3.48).
The researchers noted further efforts should be directed at understanding determinants of these sex disparities.
“The results of this study are intriguing in that they suggest that efforts to improve outcomes for esophageal cancer treatment by focusing on individualized and targeted approaches are likely to be successful in improving outcomes for future patients,” Shen said. “If the genetic and/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 individual patients’ tumors.” – by Kristie L. Kahl
For more information:
K. Robert Shen, MD, can be reached at Division of General Thoracic Surgery, May Clinic, 200 First St. SW, Rochester, MN; email: shen.krobert@mayo.edu.
Disclosures: HemOnc Today could not confirm the authors’ relevant financial disclosures at the time of reporting.