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Prediagnostic circulating levels of sex hormones and survival in esophageal adenocarcinoma

Research output: Contribution to journalArticlepeer-review

Shao Hua Xie, Eivind Ness-Jensen, Hilde Langseth, Randi E. Gislefoss, Fredrik Mattsson, Jesper Lagergren

Original languageEnglish
Pages (from-to)905-913
Number of pages9
JournalInternational Journal of Cancer
Issue number4
Accepted/In press1 Jan 2020
Published15 Feb 2021

Bibliographical note

Funding Information: This work was supported by Cancer Research UK (grant number C51246/A26163). The sponsors had no role in the study design, the collection, analysis, and interpretation of data, or the writing of the manuscript. Publisher Copyright: © 2020 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of Union for International Cancer Control. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Sex hormonal differences may contribute to the strong male predominance in esophageal adenocarcinoma (EAC), but whether sex hormone levels influence survival in EAC is unstudied. Our study aimed to assess associations between prediagnostic sex hormone levels and survival in EAC. In a population-based cohort study, 244 male EAC patients from the Janus Serum Bank Cohort in Norway were followed up through 2018. Associations between prediagnostic serum levels of 12 sex hormone measures and disease-specific mortality were assessed using multivariable Cox regression, providing hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, calendar year, body mass index, tobacco smoking, physical activity and surgical resection. Higher levels of sex hormone-binding globulin (SHBG) indicated decreased disease-specific mortality (HR 0.68, 95% CI 0.44-1.07, highest vs lowest tertile). In stratified analyses by surgery, such associations remained in nonoperated patients (HR 0.58, 95% CI 0.35-0.96, highest vs lowest tertile), but not in operated patients. Higher levels of follicle-stimulating hormone (FSH) were associated with increased disease-specific mortality in an exposure-response pattern; HRs for the middle and highest tertiles vs the lowest tertile were 1.35 (95% CI 0.89-2.05) and 1.61 (95% CI 1.06-2.43), respectively. No clear associations were observed with serum levels of dehydroepiandrosterone sulfate, luteinizing hormone, prolactin, testosterone, 17-OH-progesterone, progesterone, estradiol, androstenedione, testosterone:estradiol ratio or free testosterone index. These findings suggest that higher endogenous levels of SHBG and lower levels of FSH may increase the survival in EAC. The other 10 examined sex hormone measures may not influence the survival.

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