Sex does not reliably predict neoplastic progression in Barrett’s esophagus patients: a prospective multi-center cohort study

Females with Barrett’s esophagus (BE) are thought to be less likely to develop neoplasia. This study assessed neoplastic progression risk in females to inform surveillance management. Patients were included from three prospective BE cohorts. Multivariable Cox regression models were used to assess risk factors (including sex) for neoplastic progression (i.e., the development of high-grade dysplasia or esophageal adenocarcinoma). 3099 patients were included, of whom 866 (28%) were females. Fifty-two females (6.0%) and 206 males (9.2%) developed neoplasia during a median follow-up of 6.2 years (IQR 3.3–10.9). Although progression occurred less frequently in females than in males (0.82% vs 1.20% per patient-year), sex was just weakly associated with progression risk in multivariable analysis (HR 1.38, 95% CI 1.00–1.89). Moreover, progression rates in females and males with a BE segment ≥3 cm were similar. Furthermore, mean time to progression, tumor stage, and treatment did not differ between sexes. Therefore, sex-specific surveillance cannot be recommended.