Female Sex but Not Oestrogen Receptor Expression Predicts Survival in Advanced Gastroesophageal Adenocarcinoma-A Post-hoc Analysis of the GO2 Trial

Gastroesophageal adenocarcinoma (GOA) is a cancer that has poor survival. Most cases are diagnosed when a cure is not possible, and treatment often has many side effects. It occurs less often and is associated with better outcomes in females. The reason for this is not known. We sought to use samples from a clinical trial in older adults with GOA to investigate whether this observation could be related to oestrogen and its action through oestrogen receptors. We found no clear link between outcome and oestrogen receptor expression but did note improved survival with older age and female sex. Gastroesophageal adenocarcinoma is a disease of older adults that is associated with a very poor prognosis. It is less common and has better outcomes in females. The reason for this is unknown but may relate to signalling via the main oestrogen receptors (ER) alpha and beta. In this study, we sought to investigate this using the GO2 clinical trial patient cohort. GO2 recruited older and/or frail patients with advanced gastroesophageal cancer. Immunohistochemistry was performed on tumour samples from 194 patients. The median age of the population was 76 years (range 52-90), and 25.3% were female. Only one (0.5%) tumour sample was positive for ER alpha, compared to 70.6% for ER beta expression. There was no survival impact according to ER beta expression level. Female sex and younger age were associated with lower ER beta expression. Female sex was also associated with improved overall survival. To our knowledge, this is the largest study worldwide of ER expression in a cohort of patients with advanced gastroesophageal adenocarcinoma. It is also unique, given the age of the population. We have demonstrated that female sex is associated with better survival outcomes with palliative chemotherapy but that this does not appear to be related to ER IHC expression. The differing ER expression according to age supports the concept of a different disease biology with age.

Automated summary

Gastroesophageal adenocarcinoma (GOA) is a cancer with poor survival, but females have better outcomes. The reason for this is unknown. A study using samples from a clinical trial found no clear link between outcome and oestrogen receptor expression, but observed improved survival with older age and female sex.