Improved survival in young women with colorectal cancer
Improved survival in young women with colorectal cancer
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DOI：
10.1111/j.1572-0241.2007.01779.x
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发表时间：
2008-06-01
影响因子：
9.8
通讯作者：
Leong, Rupert W. L.
中科院分区：
文献类型：
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作者：
Koo, Jenn H.;Jalaludin, Bin;Leong, Rupert W. L.
背景技术背景：研究已经报道了性别在评估结直肠癌（CRC）生存预测因素方面的影响;然而，很少有人专门讨论性别对CRC临床和病理结局的影响。赞赏的性别差异可能有助于实施措施，以解决这些差异，并改善患者的整体结果与CRC.METHODS：西南悉尼结直肠肿瘤组登记处，其中包括人口超过80万，前瞻性收集新的CRC患者的数据。从1997年至2004年收集的数据，包括人口统计学，网站，等级，组织病理学，阶段，治疗，和survival.Results：在总数，2,050例连续患者（44%的妇女）与CRC进行了分析。与男性相比，（中位年龄69岁，范围27-95岁vs 67岁，范围22-92岁，P = 0.001），因CRC相关并发症接受急诊手术的患者更多（18.8%比15.1%，P = 0.03），有更多的近端癌Dukes B、C期直肠癌放疗率分别为36.4%、48.1%（P = 0.02）。与年轻男性相比，年轻女性（50岁及以下）的总生存率显著更高;在该组中，女性可预测总生存率的改善，与年龄、急诊手术、部位、分级和分期无关（风险比[HR] 0.46，95%置信区间[CI] 0.25-0.86，P = 0.01）。同样，年轻女性的癌症特异性生存率显著更高（HR 0.46，95% CI 0.25-0.85，P = 0.01）。然而，老年女性（年龄超过50岁）的生存率更差，与年龄、急诊手术、部位、分级和分期无关（HR 1.38，95%CI 1.14-1.68，P = 0.001）。有没有性别差异，在筛选，组织病理学，阶段，或利用chemotherapy.CONCLUSIONS：这项研究表明，在任何一方的年龄50岁的整体和癌症特异性生存的性别的相反效果。雌激素对结直肠癌的保护作用可能是一个重要因素。女性急诊手术的比例更高，这与该性别中近端癌的优势有关。妇女也有更多的近端癌症，从而限制了作为筛查测试的柔性乙状结肠镜检查。
BACKGROUND: Studies have reported the effect of gender in the context of assessing predictors of survival from colorectal cancer (CRC); however, few have specifically addressed the impact of gender on the clinical and pathological outcomes of CRC. Appreciation of gender disparities may assist in the implementation of measures to address these differences, and improve the overall outcomes of patients with CRC.METHODS: The South Western Sydney Colorectal Tumour Group registry, which encompasses a population in excess of 800,000, prospectively collects data on new patients with CRC. Data from 1997 to 2004 were collected, including demography, site, grade, histopathology, stage, treatment, and survival.RESULTS: In total, 2,050 consecutive patients (44% women) with CRC were analyzed. Compared to men, women were older (median 69 yr, range 27-95 yr vs 67, range 22-92 yr, P = 0.001), had more emergency surgery for CRC-related complications (18.8% vs 15.1%, P = 0.03), had more proximal cancers (42.2% vs 31.5%, P < 0.001), had more poorly differentiated cancers (16.9% vs 12.9%, P = 0.01), and had fewer radiotherapy treatments for Dukes B and C rectal cancers (36.4% vs 48.1%, P = 0.02). Young women (aged 50 yr and below) had significantly better overall survival compared to young men; in this group, female gender predicted improved overall survival independent of age, emergency surgery, site, grade, and stage (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.25-0.86, P = 0.01). Similarly, young women had significantly better cancer-specific survival (HR 0.46, 95% CI 0.25-0.85, P = 0.01). However, older women (aged over 50 yr) had worse survival independent of age, emergency surgery, site, grade, and stage (HR 1.38, 95% CI 1.14-1.68, P = 0.001). There were no gender differences in screening, histopathology, stage, or utilization of chemotherapy.CONCLUSIONS: This study demonstrated an opposing effect of gender on overall and cancer-specific survival at either side of the age of 50 yr. The protective effect of estrogen on CRC may be an important factor. Women had a greater proportion of emergency surgery, which was related to the predominance of proximal cancers in this gender. Women also had more proximal cancers, thereby limiting flexible sigmoidoscopy as a screening test.