Abstract 1461P
Background
Sex and gender may influence treatment allocation and outcome of cancer patients. Sex- and gender-based differences in palliative treatment and outcomes of esophagogastric cancer patients have not yet been explored. Aim of this study was to compare palliative systemic treatment administration and overall survival (OS) between male and female patients with unresectable or metastatic esophagogastric cancer.
Methods
Esophagogastric cancer patients with unresectable (cT4b) or metastatic (cM1) disease (2006-2017) were identified in the Netherlands Cancer Registry. Logistic regression analyses were used to identify the association between sex and probability of receiving palliative systemic treatment, with adjustment for relevant patient and tumor characteristics and death within 90 days after diagnosis. OS was analyzed using the Kaplan Meier method, log rank test and multivariable Cox proportional hazard regression analysis with adjustment for relevant patient and tumor characteristics, systemic treatment and resection.
Results
Of 16,337 included patients, 29% were female. Most patients had an esophageal (including cardia) adenocarcinoma (EAC; 50%), followed by gastric adenocarcinoma (GAC; 36%) and esophageal squamous cell carcinoma (ESCC; 15%). Female EAC and GAC patients had a lower chance of receiving systemic treatment compared to men (37% vs 43% and 35% vs 38%), also in multivariable analyses (OR 0.86, 95% CI 0.74-0.99; 0.84, 95% CI 0.73-0.96, respectively). This difference was not observed in ESCC (30% vs 32%; OR 0.92 95% CI 0.75-1.13). Women with EAC had a lower median OS (4.5 vs. 5.2 months), which disappeared after adjustment for confounders (HR 1.05, 95% CI 0.99-1.14). Median OS in female ESCC patients was superior to men (6.2 vs 5.4 months; HR 0.85, 95% CI 0.78-0.92). Women with GAC patients had a comparable median OS (3.7 vs 3.8 months), which was superior in multivariable analyses (HR 0.93, 95% CI 0.94-1.00).
Conclusions
We observed differences in systemic treatment administration and OS between men and women with unresectable or metastatic esophagogastric cancer. Causes of these differences are probably both sex-based, e.g. tumor biology, and gender-based, e.g. treatment choices.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
R.H. Verhoeven: Research grant/Funding (institution): Roche; Research grant/Funding (institution): BMS. A.D. Wagner: Advisory/Consultancy: BMS; Advisory/Consultancy: Servier Suisse; Advisory/Consultancy: Merck; Advisory/Consultancy: MSD; Advisory/Consultancy: Bayer; Advisory/Consultancy: EMD Serono; Advisory/Consultancy: Lilly; Advisory/Consultancy: Celgene; Advisory/Consultancy: Shire; Advisory/Consultancy: Pfizer; Travel/Accommodation/Expenses: Sanofi; Travel/Accommodation/Expenses: AstraZeneca; Travel/Accommodation/Expenses: AbbVIE; Travel/Accommodation/Expenses: Ipsen; Research grant/Funding (institution): Roche. V.E.P.P. Lemmens: Research grant/Funding (institution): Roche. M.G.H. van Oijen: Research grant/Funding (institution): BMS; Research grant/Funding (institution): Amgen; Research grant/Funding (institution): Lilly; Research grant/Funding (institution): Nordic; Research grant/Funding (institution): Merck; Research grant/Funding (institution): Roche; Research grant/Funding (institution): Servier. S.S. Gisbertz: Research grant/Funding (institution): Olympys; Advisory/Consultancy: Medtronic. M.I. van Berge Henegouwen: Research grant/Funding (institution): Olympus; Research grant/Funding (institution): Stryker; Advisory/Consultancy: Medtronic; Advisory/Consultancy: Mylan; Advisory/Consultancy: Johnson and Johnson. H.W.M. van Laarhoven: Advisory/Consultancy, Research grant/Funding (institution): BMS; Advisory/Consultancy, Research grant/Funding (institution): Celgene; Advisory/Consultancy, Research grant/Funding (institution): Nordic; Advisory/Consultancy, Research grant/Funding (institution): Lilly; Research grant/Funding (institution): Roche; Advisory/Consultancy, Research grant/Funding (institution): Merck; Advisory/Consultancy, Research grant/Funding (institution): Servier; Research grant/Funding (institution): Bayer; Research grant/Funding (institution): MSD; Research grant/Funding (institution): Philips. All other authors have declared no conflicts of interest.