title: Influence of sex on the survival of patients with esophageal cancer.
abstract: OBJECTIVE
  The prognostic value of sex for esophageal cancer survival is currently unclear, and growing data suggest that hormonal influences may account for incidence disparities between men and women. Therefore, moving from the hypothesis that hormones could affect the prognosis of patients with esophageal cancer, we investigated the primary hypothesis that sex is associated with survival and the secondary hypotheses that the relationship between sex and survival depends, at least in part, on age, histology, and race/ethnicity.
  
  
  METHODS
  By using the SEER databases from 1973 to 2007, we identified 13,603 patients (34%) with metastatic esophageal cancer (MEC) and 26,848 patients (66%) with locoregional esophageal cancer (LEC). Cox proportional hazards model for competing risks were used for analyses.
  
  
  RESULTS
  In the multivariate analysis, women had longer esophageal cancer-specific survival (ECSS) than men in both MEC (hazard ratio [HR], 0.949; 95% CI, 0.905 to 0.995; P = .029) and LEC (HR, 0.920; 95% CI, 0.886 to 0.955; P < .001) cohorts. When age and histology were accounted for, there was no difference for ECSS between men and women with adenocarcinoma. In contrast, women younger than age 55 years (HR, 0.896; 95% CI, 0.792 to 1.014; P = .081) and those age 55 years or older (HR, 0.905; 95% CI, 0.862 to 0.950; P < .001) with squamous cell LEC had longer ECSS than men. In the squamous cell MEC cohort, only women younger than age 55 years had longer ECSS (HR, 0.823; 95% CI, 0.708 to 0.957; P = .011) than men.
  
  
  CONCLUSIONS
  Sex is an independent prognostic factor for patients with LEC or MEC. As secondary hypotheses, in comparison with men, women age 55 years or older with squamous cell LEC and women younger than age 55 years with squamous cell MEC have a significantly better outcome. These last two findings need further validation.
authors.affiliation: USC/Norris Comprehensive Cancer Center, Keck School of Medicine, 1441 Eastlake Ave, Room 3456, Los Angeles, CA 90033, USA.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bohanes
authors.forename: Dongyun
authors.initials: D
authors.lastname: Yang
authors.forename: Ruchika S
authors.initials: RS
authors.lastname: Chhibar
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Labonte
authors.forename: Thomas
authors.initials: T
authors.lastname: Winder
authors.forename: Yan
authors.initials: Y
authors.lastname: Ning
authors.forename: Armin
authors.initials: A
authors.lastname: Gerger
authors.forename: Léonor
authors.initials: L
authors.lastname: Benhaim
authors.forename: David
authors.initials: D
authors.lastname: Paez
authors.forename: Takeru
authors.initials: T
authors.lastname: Wakatsuki
authors.forename: Fotios
authors.initials: F
authors.lastname: Loupakis
authors.forename: Rita
authors.initials: R
authors.lastname: El-Khoueiry
authors.forename: Wu
authors.initials: W
authors.lastname: Zhang
authors.forename: Heinz-Josef
authors.initials: HJ
authors.lastname: Lenz
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality; D004938:Esophageal Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012727:Sex Characteristics; D055815:Young Adult