Sex Disparity in Patients with Gastric Cancer: A Systematic Review and Meta-Analysis

Abstract

Objective. This systematic review and meta-analysis aimed to ascertain whether sex-based differences influence clinicopathological characteristics and survival outcomes of gastric cancer patients. Background. Gastric cancer in females has received less attention than in males. Clinicopathological features and survival outcomes of females with gastric cancer have been reported in several studies with controversial results. Methods. We systematically reviewed clinical studies from PubMed, Cochrane Library, Embase, and Web of Science published up to June 2022. The effect sizes of the included studies were estimated using odds ratios (ORs). Heterogeneity was investigated using the χ2 and I2 tests, while sensitivity analyses were performed to identify the source of substantial heterogeneity. All data used in this study were obtained from previously published studies obviating the need for ethical approval and patient consent. Results. Seventy-six studies with 775,003 gastric cancer patients were included in the meta-analysis. Gastric cancer patients were less likely to be females ( $P$  < 0.00001). Female patients were younger in age ( $P$  < 0.00001) and showed a higher percentage of distal ( $P$  < 0.00001), non-cardia ( $P$  < 0.00001), undifferentiated ( $P$  < 0.00001), diffuse ( $P$  < 0.00001), and signet-ring cell carcinoma ( $P$  < 0.00001). Female patients showed better prognosis in both 3-year ( $P$  = 0.0003) and 5-year overall survival (OS) ( $P$ < 0.00001), especially White patients. However, females were associated with lower 5-year OS relative to males in the younger patients ( $P$  = 0.0001). Conclusions. In conclusion, gender differences were observed in clinicopathological characteristics and survival outcomes of gastric cancer. Different management of therapy will become necessary for different genders.