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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Sex-based differences in histology, staging, and prognosis among 2983 gastric cancer surgery patients
Yonghoon Choi, Nayoung Kim, Ki Wook Kim, Hyeong Ho Jo, Jaehyung Park, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Dong Ho Lee, Hyeon Jeong Oh, Hye Seung Lee, Young Suk Park, Sang-Hoon Ahn, Yun-Suhk Suh, Do Joong Park, Hyung-Ho Kim, Ji-Won Kim, Jin Won Kim, Keun-Wook Lee, Won Chang, Ji Hoon Park, Yoon Jin Lee, Kyoung Ho Lee, Young Hoon Kim
Yonghoon Choi, Nayoung Kim, Ki Wook Kim, Hyeong Ho Jo, Jaehyung Park, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Dong Ho Lee, Ji-Won Kim, Jin Won Kim, Keun-Wook Lee, Department ofInternal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
Nayoung Kim, Dong Ho Lee, Keun-Wook Lee, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
Hyeon Jeong Oh, Department of Pathology, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
Hye Seung Lee, Department of Pathology, Seoul National University College of Medicine, Seoul 03080, South Korea
Young Suk Park, Sang-Hoon Ahn, Yun-Suhk Suh, Hyung-Ho Kim, Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
Yun-Suhk Suh, Do Joong Park, Hyung-Ho Kim, Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
Won Chang, Ji Hoon Park, Yoon Jin Lee, Kyoung Ho Lee, Young Hoon Kim, Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
Kyoung Ho Lee, Young Hoon Kim, Department of Radiology, Seoul National University College of Medicine, Seoul 03080, South Korea
Author contributions: Choi Y analyzed the data, provided statistical support, and drafted the article; Kim N designed this study, collected the data, and edited the manuscript; Kim KW, Jo HH, Park J, Yoon H, Shin CM, Park YS, and Lee DH performed endoscopies for the diagnosis of gastric cancer and edited the text; Park YS, Ahn SH, Suh YS, and Park DJ performed surgeries for gastric cancer; Kim HH kindly provided surgical cohort information, advised on the design of this study and supervised the manuscript preparation; HJO and HSL performed the histologic diagnosis of gastric cancer; Kim JW, Kim JW and Lee KW administered chemotherapy to patients with advanced gastric cancer; and Chang W, Park JH, Lee YJ, Lee KH, and Kim YH performed the radiologic studies; all authors reviewed the final manuscript and provided comments.
Supported by National Research Foundation of Korea.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of SNUBH (IRB No. B-1902–523-107).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: To gain access to data, data requestors will need to sign a data access agreement. Proposals should be directed to the Ethics Committee of Seoul National University Bundang Hospital.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Nayoung Kim, MD, PhD, Professor, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, South Korea. nakim49@snu.ac.kr
Received: September 19, 2021
Peer-review started: September 19, 2021
First decision: November 7, 2021
Revised: November 8, 2021
Accepted: January 27, 2022
Article in press: January 27, 2022
Published online: March 7, 2022
BACKGROUND
Few studies have been conducted on sex differences in the incidence, pathophysiology, and prognosis of gastric cancer (GC).
AIM
To analyze the differences in GC characteristics according to sex in patients who underwent surgical treatment for GC.
METHODS
A total of 2983 patients diagnosed with gastric adenocarcinoma who received surgical treatment at the Seoul National University Bundang Hospital between 2003 and 2017 were included. Baseline clinicopathological characteristics, histologic type of GC, overall and GC-specific survival rates, and associated risk factors were analyzed.
RESULTS
Among the 2983 patients, 2005 (67.2%) and 978 (32.8%) were males and females, respectively. The average age of the female group (59.36 years) was significantly younger than that of the male group (61.66 years; P < 0.001). Cancer of the gastric body (P < 0.001) and diffuse-type histology (P < 0.001) were more common in females than in males. This trend was more prominent in females younger than 60 years of age, with a significantly higher proportion of diffuse-type cancer than in the male group. Regardless of sex, diffuse-type GC was more common in younger patients, and the proportion of intestinal-type GC increased with age. The overall survival rate was significantly higher in females (P < 0.001). However, this difference disappeared for GC-specific survival (P = 0.168), except for the poor GC-specific survival rate in advanced-stage cancer (stage III or above) in females (P = 0.045). The risk factors for GC-related mortality were older age, upper location of GC, and diffuse- or mixed-type histology. In terms of comorbidities, more males died from diseases other than GC, including other malignancies such as lung cancer, hepatocellular carcinoma, and pancreatic cancer, and respiratory diseases such as interstitial lung disease and chronic obstructive pulmonary disease, while there were relatively more cardiovascular or cerebrovascular deaths in females.
CONCLUSION
Sex-based differences in GC were observed in clinicopathological features, including age at diagnosis, tumor location, histologic type, survival rate, and comorbidities.
Core Tip: In the analyses of sex differences in gastric cancer (GC), the sex ratio between males and females was 2:1, but the incidence of diffuse-type cancer was higher in females until the age of 60 years. The average age of the female group was significantly younger, and cancer of the gastric body and diffuse-type histology were more common than those in the males. In addition, there was poor GC-specific survival rate in advanced-stage cancer in females, while comorbidities including cancers of other organs and respiratory diseases were more common in males.
