Annals of Surgical Oncology

, Volume 23, Issue 13, pp 4344–4351 | Cite as

Sex Disparity in Gastric Cancer: Female Sex is a Poor Prognostic Factor for Advanced Gastric Cancer

  • Hae Won Kim
  • Jie-Hyun KimEmail author
  • Beom Jin LimEmail author
  • HyunKi Kim
  • Hoguen Kim
  • Jae Jun Park
  • Young Hoon Youn
  • Hyojin Park
  • Sung Hoon Noh
  • Jong Won Kim
  • Seung Ho Choi
Gastrointestinal Oncology



The overall incidence of gastric cancer (GC) is higher in males than females. Specifically, signet ring cell carcinoma (SRC) is more frequently observed in younger female patients. However, limited information focused on sex-specific differences in GC has been reported. The aim of our study was to analyze clinicopathological differences between sex groups to reveal sex disparities in GC.


We retrospectively analyzed 4722 patients with GC who underwent gastrectomy (females: 1586 (33.6 %); males: 3136 (66.4 %), and analyzed clinicopathological features between these sex groups. The overall survival (OS) rate was investigated between the two sex groups, with special reference to the pathologic World Health Organization GC classifications. Immunohistochemistry staining of sex hormone receptors, including the estrogen receptor (ER)-α, ER-β, progesterone receptor, and androgen receptor, was performed according to sex and pathological classification.


Female patients were significantly associated with a younger age, poorly differentiated adenocarcinoma, and SRC compared with males. Female patients showed a significantly poorer OS than male patients, especially among those with advanced GC (AGC) aged ≤45 years. In females with AGC, those with SRC had a significantly poorer OS than those with other histologies. Moreover, the expression of ER-β was different between females and males with SRC.


Females with GC were significantly younger and had a different SRC histology compared with males. Furthermore, females had significantly poorer prognostic factors among young patients with SRC. Thus, young female GC patients with SRC are a main target group in which to improve prognosis.


Gastric Cancer Overall Survival Androgen Receptor Gastric Cancer Tissue Signet Ring Cell Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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Author Contribution

Hae Won Kim made substantial contributions to the conception and design of the study, analysis and interpretation of data, drafting the article, and critically revising it for important intellectual content. Jie-Hyun Kim and Beom Jin Lim made substantial contributions to the conception and design of the study, final approval of the version to be published, and agreement to be accountable for all aspects of the work. HyunKi Kim, Hoguen Kim, Jae Jun Park, Young Hoon Youn, Hyojin Park, Sung Hoon Noh, Jong Won Kim, and Seung Ho Choi critically revised the article for important intellectual content.


This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), and was funded by the Ministry of Education, Science and Technology (2012R1A1A1042417).


Hae Won Kim, HyunKi Kim, Hoguen Kim, Jae Jun Park, Young Hoon Youn, Hyojin Park, Sung Hoon Noh, Jong Won Kim, Seung Ho Choi, Jie-Hyun Kim and Beom Jin Lim have no disclosures to declare.

Supplementary material

10434_2016_5448_MOESM1_ESM.docx (408 kb)
Supplementary material 1 (DOCX 408 kb)


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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Hae Won Kim
    • 1
    • 4
  • Jie-Hyun Kim
    • 1
    • 4
    • 5
    Email author
  • Beom Jin Lim
    • 2
    • 4
    Email author
  • HyunKi Kim
    • 2
  • Hoguen Kim
    • 2
  • Jae Jun Park
    • 1
    • 4
  • Young Hoon Youn
    • 1
    • 4
  • Hyojin Park
    • 1
    • 4
  • Sung Hoon Noh
    • 3
  • Jong Won Kim
    • 3
    • 4
  • Seung Ho Choi
    • 3
    • 4
  1. 1.Department of Internal Medicine, Institute of GastroenterologyYonsei University College of MedicineSeoulKorea
  2. 2.Department of Pathology, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea
  3. 3.Department of Surgery, Institute of GastroenterologyYonsei University College of MedicineSeoulKorea
  4. 4.Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea
  5. 5.Department of Internal Medicine, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea

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