Impact of sex and age on chemotherapy efficacy, toxicity and survival in localised oesophagogastric cancer: A pooled analysis of 3265 individual patient data from four large randomised trials (OE02, OE05, MAGIC and ST03)

Avani Athauda, Matthew Nankivell, Ruth E. Langley, Derek Alderson, William Allum, Heike I. Grabsch, Naureen Starling, Ian Chau, David Cunningham*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

15 Citations (Web of Science)


Background: There is a lack of large-scale randomised data evaluating the impact of sex and age in patients undergoing chemotherapy followed by potentially curative surgery for oesophagogastric cancer.

Patients and methods: Individual patient data from four prospective randomised controlled trials were pooled using a two-stage meta-analysis. For survival analysis, hazard ratios (HRs) were calculated for patients aged = 70 years, as well as between males and females. Mandard tumour regression grade (TRG) and, >= grade III toxicities were compared using logistic regression models to calculate odds ratios. All analyses were adjusted for the type of chemotherapy received.

Results: 3265 patients were included for survival analysis (2668 [82%] male, 597 [18%] female; 2627 (80%) = 70 years). A significant improvement in overall survival (OS) (HR: 0.78; p <0.001) and disease-specific survival (DSS) (HR: 0.78; p <0.001) was observed in females compared with males. No significant differences in OS (HR: 1.11; p = 0.045) or DSS (HR: 1.01; p = 0.821) were observed in older patients compared with younger patients.

For patients who underwent resection, older patients (15% vs 10%; p = 0.03) and female patients (14% vs 10%, p = 0.10) were more likely to achieve favourable Mandard TRG scores. Females experienced significantly more >= grade III nausea (10% vs 5%; p

Conclusions: In this large pooled analysis using prospective randomised trial data, females had significantly improved survival while experiencing more gastrointestinal toxicities. Older pa-tients achieved comparable survival to younger patients and thus, dependent on fitness, should be offered the same treatment paradigm. (c) 2020 The Authors. Published by Elsevier Ltd.

Original languageEnglish
Pages (from-to)45-56
Number of pages12
JournalEuropean Journal of Cancer
Publication statusPublished - Sep 2020


  • Age
  • Sex
  • Oesophageal cancer
  • Gastric cancer
  • Chemotherapy
  • Survival
  • RISK

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