Unique Considerations for Females Undergoing Esophagectomy

Area of Science:

• Oncology
• Surgical Oncology
• Cancer Epidemiology

Background:

• Esophageal cancer predominantly affects males; sex differences in clinical presentation, treatment, and outcomes are understudied.
• Existing research has not sufficiently considered sex as a critical factor in esophageal cancer diagnosis or management.

Purpose of the Study:

• To elucidate sex-based disparities in clinicopathologic features, treatment strategies, and patient outcomes following esophagectomy for esophageal cancer.
• To determine if sex influences the presentation and management of esophageal cancer, particularly in patients with locoregional disease.

Main Methods:

• A retrospective analysis was conducted on 1958 patients who underwent esophagectomy for esophageal cancer between 1995 and 2017.
• Data collected included demographics, clinicopathologic characteristics, treatment received, and postoperative outcomes, with a focus on sex differences.

Main Results:

• Female patients (21%) had a higher incidence of squamous cell carcinoma (35% vs. 11%) and lower rates of smoking and heavy alcohol use compared to males.
• While overall survival and postoperative mortality were similar, female patients with locoregional disease received neoadjuvant therapy less frequently and had worse overall survival.
• Previous mediastinal radiation was more common in females (8.4% vs. 1.8%), and this factor, along with potential treatment bias, may contribute to observed outcome differences.

Conclusions:

• Female patients exhibit distinct esophageal cancer profiles, including a higher prevalence of squamous cell carcinoma despite fewer risk factors.
• Undertreatment of locoregional esophageal cancer in females may stem from treatment bias or prior radiation exposure, necessitating tailored management approaches.
• Esophageal cancer in females should be recognized as a unique clinical entity requiring distinct diagnostic and therapeutic considerations compared to males.