Sex disparities in cancer mortality and survival.
Sex disparities in cancer mortality and survival.
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癌症死亡率和生存中的性别差异。
DOI：
10.1158/1055-9965.epi-11-0246
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发表时间：
2011-08
期刊：
影响因子：
--
通讯作者：
Anderson WF
中科院分区：
文献类型：
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作者：
Cook MB;McGlynn KA;Devesa SS;Freedman ND;Anderson WF
以前的研究已经注意到男性的癌症死亡率高于女性，存活率低于女性。然而，按性别对这两个指标进行系统比较的情况有限。我们从监测、流行病学和最终结果数据库中提取了1977年至2006年期间按性别和年龄划分的36种癌症的生命率和生存率数据。我们比较了性别特异性死亡率和男女死亡率比（MRR）。我们还提取了病例数据，包括年龄和诊断日期，性别，原发癌部位，肿瘤分期和分级，生存时间，生命状态和死亡原因。采用考克斯比例风险模型估计诊断后5年内死亡的相对癌症特异性风险比（HR），并校正协变量。对于绝大多数癌症，男性的年龄调整死亡率高于女性，唇（5.51）、喉（5.37）、下咽（4.47）、食管（4.08）和膀胱（3.36）的男性对女性MRR最高。对于大多数癌症，男性的癌症特异性生存率比女性差，但这种差异远远低于相应的MRR;例如，唇（HR = 0.93）、喉（1.09）、下咽（0.98）、食管（1.05）和膀胱（0.83）。男性与女性的MRR差异显着，而癌症生存差异则不太明显。这表明性别相关的癌症差异与病因学的关系比与预后的关系更密切。未来的分析研究应试图了解观察到的癌症性别差异的原因。
Previous research has noted higher cancer mortality rates and lower survival among males than females. However, systematic comparisons of these two metrics by sex has been limited. We extracted U.S. vital rates and survival data from the Surveillance, Epidemiology and End Results Database for 36 cancers by sex and age for the period 1977–2006. We compared sex-specific mortality rates and male-to-female mortality rate ratios (MRRs). We also extracted case data which included age and date of diagnosis, sex, primary cancer site, tumor stage and grade, survival time, vital status, and cause of death. Relative cancer-specific hazard ratios (HRs) for death in the 5-year period following diagnosis were estimated with Cox proportional hazards models, adjusted for covariates. For the vast majority of cancers, age-adjusted mortality rates were higher among males than females with the highest male-to-female MRR for lip (5.51), larynx (5.37), hypopharynx (4.47), esophagus (4.08) and urinary bladder (3.36). Cancer-specific survival was, for most cancers, worse for males than females, but such disparities were drastically less than corresponding MRRs; e.g., lip (HR = 0.93), larynx (1.09), hypopharynx (0.98), esophagus (1.05), and urinary bladder (0.83). Male-to-female MRRs differed markedly while cancer survival disparities were much less pronounced. This suggests that sex-related cancer disparities are more strongly related to etiology than prognosis. Future analytical studies should attempt to understand causes of observed sex disparities in cancer.