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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
ARTICLE HIGHLIGHTS
Research background
Despite the nationwide large-scale screening campaign, the incidence of gastric cancer (GC) in Korea is still high. The incidence is approximately twice as high in males than in females.
Research motivation
However, studies so far have not fully explained the different characteristics of GC between the sexes. These differences might be due to the difference in exposure to the known risk factors for GC, such as frequent Helicobacter pylori infection, smoking, and alcohol consumption in males, but we thought that there is a possibility that sex hormones were based on this difference.
Research objectives
This study aimed to analyze sex-based differences in clinicopathological features, staging, survival, and comorbidities in GC.
Research 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, and clinicopathological characteristics, histologic type of GC, overall and GC-specific survival rates, and associated risk factors were analyzed.
Research results
The male to female ratio was 2:1, and the average age of the female group was lower than that of the male group. Diffuse-type GC was more common in younger patients, especially in females younger than 60 years of age, and the proportion of intestinal-type GC increased with age. The overall survival rate was significantly higher in females, whereas GC-specific survival tended to be higher in males. Comorbidities, including other malignancies and respiratory diseases, are more common in males.
Research conclusions
Differences in the epidemiology of GC incidence, including a higher proportion of diffuse-type histology, mortality, including poorer survival in the advanced stage in females, and comorbidities were observed. These differences may be due to hormonal factors.
Research perspectives
We believe that a larger study including patients who received non-surgical treatment is needed. Individual sex hormone data, including menopause, childbirth, and breastfeeding, would be analyzed to prove the protective effect of estrogen against intestinal-type GC.
