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Gender differences in clinicopathological features and prognosis of squamous cell carcinoma of the esophagus

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Abstract

Background

Esophageal squamous cell carcinoma (ESCC) is more frequent in male, and female ESCC patients have better prognosis and tend to diagnose at an earlier stage than male. Regarding these female advantages, gender differences of immunological reaction and sex hormone relations were investigated previously. However, the gender differences of clinicopathological features and prognostic factors of ESCC remain well unknown.

Methods

A total of consecutive 170 Japanese patients, including 28 females with ESCC who newly diagnosed and underwent esophagectomy between January 2004 and March 2013 in our institute, were examined. Clinicopathological features and p53 expression, a potent biomarker reflecting chemoresistance and prognosis, were compared. Prognostic factors were analyzed using a multivariate analysis.

Results

The rates of current drinking, flusher, smoking habits, and Brinkman index in female were lower than those in male (p < 0.001). Tumor location, tumor differentiation, T factor, N factor, clinical stage, and contents of initial treatment had no gender differences. Especially, in the population that received neoadjuvant chemotherapy, excellent pathological effectiveness (>Grade2) was seen much more in female significantly (36.1:66.7 %, p = 0.048). Immunohistostaining revealed positive rates of p53 expression were significantly high in male (50.4:30.5 %, p = 0.007). Postoperative complication occurred more frequently in male than female (52.8:28.6 %, p = 0.024). Estimated 5-year disease-specific survivals by Kaplan–Meier method were worse in male than female at rates of 46.2 and 76.7 %, respectively (p = 0.045). Multivariate analysis by Cox’s proportional hazards model showed that female gender (HR: 0.508, p = 0.023) and tumor depth (HR: 0.572, p = 0.018) were independent prognostic factors of ESCC after resection.

Conclusions

Female ESCC showed prefer prognosis to male ESCC. Low p53 imunohistochemical expression in the female ESCC patients might be related with higher sensitivity to neoadjuvant chemotherapy.

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References

  1. Ozawa S, Tachimori Y, Baba H, Fujishiro M, Matsubara H, Numasaki H, et al. Comprehensive registry of esophageal cancer in Japan. Esophagus. 2011;8:9–29.

    Article  Google Scholar 

  2. Castellsague X, Munoz N, De Stefani E, Victora CG, Castelletto R, Rolon PA, et al. Independent and joint effects of tobacco smoking and alcohol drinking on the risk of esophageal cancer in men and women. Int J Cancer. 1999;82:657–64.

    Article  CAS  PubMed  Google Scholar 

  3. Sugimachi K, Matsuoka H, Matsufuji H, Maekawa S, Kai H, Okudaira Y. Survival rates of women with carcinoma of the esophagus exceed those of men. Surg Gynecol Obstet. 1987;164:541–4.

    CAS  PubMed  Google Scholar 

  4. Koide N, Kitazawa M, Komatsu D, Suzuki A, Miyagawa S. Gender differences in clinicopathologic features and outcomes of esophageal cancer patients treated surgically. Esophagus. 2011;8:107–12.

    Article  Google Scholar 

  5. Thrift AP, Nagle CM, Fahey PP, Russell A, Smithers BM, Watson DI, et al. The influence of prediagnostic demographic and lifestyle factors on esophageal squamous cell carcinoma survival. Int J Cancer. 2012;131:759–68.

    Article  Google Scholar 

  6. Kalayarasan R, Ananthakrishnan N, Kate V, Basu D. Estrogen and progesterone receptors in esophageal carcinoma. Dis Esophagus. 2008;21:298–303.

    Article  CAS  PubMed  Google Scholar 

  7. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  8. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.

    Article  CAS  Google Scholar 

  9. Japan Esophageal Society. Japanese classification of esophageal cancer, 10th edition: part I. Esophagus. 2009;6:1–25.

    Article  Google Scholar 

  10. Yokoyama A, Muramatsu T, Omori T, Yokoyama T, Matsushita S, Higuchi S, et al. Alcohol and aldehyde dehydrogenase gene polymorphisms and oropharyngeal, esophageal and stomach cancers in Japanese alcoholics. Crsinogenesis. 2001;22:433–9.

    Article  CAS  Google Scholar 

  11. Morita M, Otsu H, Kawano H, Kasagi Y, Kimura Y, Saeki H, et al. Gender differences in prognosis after esophagectomy for esophageal cancer. Surg Today. 2014;44:505–12.

    Article  PubMed  Google Scholar 

  12. Morisaki Y, Yosizumi Y, Koike K, Aiko S, Sugiura Y, Shima S, et al. The influence of gender on prognosis in esophageal carcinoma (in Japanese with English abstract). J Natl Def Med Coll. 1998;23:21–6.

    Google Scholar 

  13. Shiozaki H, Ogawa K, Kobayashi K, Yano T, Inoue M, Kubota T, et al. Sexual difference on prognosis of esophageal cancer (in Japanese). Jpn J Gastroenterol Surg (Nihon Shokakigeka Gakkai Zasshi). 1985;18:1967–72.

    Article  Google Scholar 

  14. Ueo H, Matsuoka H, Sugimachi K, Kuwano H, Mori M, Akiyoshi T. Inhibitory effects of estrogen on the growth of a human esophageal carcinoma cell line. Cancer Res. 1990;50:7212–5.

    CAS  PubMed  Google Scholar 

  15. Ando N, Kato H, Igaki H, Shinoda M, Ozawa S, Shimizu H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.

    Article  PubMed  Google Scholar 

  16. Yoshida T, Seike J, Miyoshi T, Yamai H, Takechi H, Yuasa Y, et al. Preoperative chemotherapy with weekly docetaxel plus low-dose cisplatin and 5-fl uorouracil for stage II/III squamous cell carcinoma of the esophagus. Esophagus. 2010;7:95–100.

    Article  Google Scholar 

  17. Offner PJ, Moore EE, Biffl WL. Male gender is a risk factor for major infections after surgery. Arch Surg. 1999;134:935–40.

    Article  CAS  PubMed  Google Scholar 

  18. Wichmann MW, Zellweger R, DeMaso CM, Ayala A, Chaudry IH. Enhanced immune responses in females, as opposed to decreased responses in males following haemorrhagic shock and resuscitation. Cytokine. 1996;8:853–63.

    Article  CAS  PubMed  Google Scholar 

  19. Bohanes P, Yang D, Chhibar RS, Labonte MJ, Winder T, Ning Y, et al. Influence of sex on the survival of patients with esophageal cancer. J Clin Oncol. 2012;30:2265–72.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hidaka H, Hotokezaka M, Nakashima S, Uchiyama S, Maehara N, Chijiiwa K. Sex difference in survival of patients treated by surgical resection for esophageal cancer. World J Surg. 2007;31:1982–7.

    Article  PubMed  Google Scholar 

  21. Hollstein MC, Metcalf RA, Welsh JA, Montesano R, Harris CC. Frequent mutation of the p53 gene in human esophageal cancer. Proc Natl Acad Sci. 1990;87:9958–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Kato H, Yoshikawa M, Miyazaki T, Nakajima M, Fukai Y, Tajima K, et al. Expression of p53 protein related to smoking and alcoholic beverage drinking habits in patients with esophageal cancers. Cancer Lett. 2001;167:65–72.

    Article  CAS  PubMed  Google Scholar 

  23. Zhang SS, Huang QY, Yang H, Xie X, Luo KJ, Wen J, et al. Correlation of p53 status with the response to chemotherapy-based treatment in esophageal cancer: a meta-analysis. Ann Surg Oncol. 2013;20:2419–27.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan

    Takeshi Nishino, Takahiro Yoshida, Seiya Inoue, Satoshi Fujiwara, Masakazu Goto, Takuya Minato, Yoshihito Furukita, Yota Yamamoto, Yasuhiro Yuasa, Hiromichi Yamai, Hirokazu Takechi, Hiroaki Toba, Hiromitsu Takizawa, Mitsuteru Yoshida, Junichi Seike, Takanori Miyoshi & Akira Tangoku

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  1. Takeshi Nishino
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  2. Takahiro Yoshida
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  16. Takanori Miyoshi
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  17. Akira Tangoku
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Corresponding author

Correspondence to Takeshi Nishino.

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Ethical Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study. If doubt exists whether the research was conducted in accordance with the Helsinki Declaration, the authors must explain the rationale for their approach, and demonstrate that the institutional review body explicitly approved the doubtful aspects of the study. Identifying information of patients of human subjects, including names, initials, addresses, admission dates, hospital numbers, or any other data that might identify patients should not be published in written descriptions, photographs, or pedigrees unless the information is essential for scientific purposes and the patient (or parent guardian) gives written informed consent for publication. If any identifying information about patients is included in the article, the following sentence should also be included: Additional informed consent was obtained from all patients for which identifying information is included in this article.

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There are no financial or other relations that could lead to conflict of interest.

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Nishino, T., Yoshida, T., Inoue, S. et al. Gender differences in clinicopathological features and prognosis of squamous cell carcinoma of the esophagus. Esophagus 14, 122–130 (2017). https://doi.org/10.1007/s10388-016-0554-4

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