Men and Women Have Different Outcomes of Gastric Cancer Treatment

Men and women with gastric cancer may have different outcomes of preoperative chemotherapy and surgery, according to research published in the Journal of Surgical Oncology.

Data from the CRITICS trial showed that women with gastric cancer were more likely than their male counterparts to have positive margins after surgery and to experience adverse events related to neoadjuvant chemotherapy.

The phase 3 CRITICS trial (ClinicalTrials.gov identifier: NCT00407186) included 781 patients — 529 men and 259 women — with resectable gastric cancer. The patients received preoperative chemotherapy and underwent surgery. They were then randomly assigned to receive either chemotherapy or chemoradiotherapy.

Baseline characteristics were generally similar between men and women. However, diffuse-type gastric cancer was more common in women, and women were more likely to have distal tumor localization. Among patients with diffuse-type gastric cancer, women were diagnosed at a significantly younger age than men.

Preoperative chemotherapy was more likely to cause severe toxicity among women than among men — 71% and 63%, respectively (P =.015). Rates of severe toxicity related to postoperative chemotherapy (P =.323) or chemoradiotherapy (P =.705) were similar between the sexes.

Among patients with diffuse‐type gastric cancer, women were more likely than men to have positive margins after surgery — 21% and 10%, respectively (P =.020). Positive margins involved the duodenal end in 65% of women and 47% of men with diffuse‐type disease.

The 5-year overall survival (OS) rate was higher in patients with intestinal-type gastric cancer than in patients with diffuse-type disease — 51% and 34%, respectively (hazard ratio [HR], 1.65; 95% CI, 1.36-2.01; P <.001).

There was no significant difference in OS outcomes between the sexes for the entire cohort (HR, 1.16; 95% CI, 0.96-1.43; P =.13), in patients with intestinal-type gastric cancer (HR, 0.88; 95% CI, 0.63-1.26; P =.51), or in those with diffuse-type disease (HR, 1.18; 95% CI, 0.91-1.52; P =.21).

“[B]oth sex and histological subtypes have an impact on gastric cancer, its treatment, and outcome,” the researchers wrote. “Based on these results, we support the notion that males and females should be considered as distinct groups of patients and emphasize that clinicians should be aware of these differences in toxicity and in surgical outcomes.”

This article originally appeared on Cancer Therapy Advisor