Schrader A J, Sevinc S, Olbert P J, Hegele A, Varga Z, Hofmann R
Klinik für Urologie und Kinderurologie, Philipps-Universität Marburg, Marburg, Deutschland.
Urologe A. 2008 Sep;47(9):1182, 1184-6. doi: 10.1007/s00120-008-1832-0.
Renal cell carcinoma (RCC) occurs twice as often in men as in women; however, the influence of gender on stage, grade, subtype and prognosis has not been studied in detail.
This study included 780 patients treated by (partial) nephrectomy at our institution in Marburg between 1990 and 2005. The mean follow-up was 5.44 years.
Of the 780 patients, 486 (62%) were men and 294 (38%) were women. Women were significantly older (mean, 65.3 vs. 62.2 years; p<0.001, t-test), presented at lower T stages (p=0.046, chi(2)) and suffered metastasis less frequently at diagnosis (p=0.026, chi(2)). In addition, women more frequently had clear cell tumours (85.2% vs. 78.3%) and less frequently papillary tumours (11.0% vs. 18.8%) than men (p=0.026, chi(2)). In contrast, men had an increased risk of death from RCC (HR 1.23, CI 0.92-1.63); Kaplan-Meier curves revealed a significant difference in tumour-specific survival between men and women (p=0.033, log rank; 5-year survival 74% vs. 83%). However, unlike tumour stage and tumour grade, gender could not be retained as a significant independent prognostic marker in multivariate analysis.
In general, RCC in men is characterized by higher tumour stages and more frequent metastasis at diagnosis along with inferior tumour-specific survival. However, as gender failed to qualify as an independent prognostic marker for tumour-specific survival, delayed diagnosis due to insufficient routine medical check-up and/or a more aggressive tumour biology might be be a concurrent cause. Thorough regular medical check-ups for men, also with regard to RCC, are thus mandatory.
肾细胞癌（RCC）在男性中的发病率是女性的两倍；然而，性别对分期、分级、亚型及预后的影响尚未得到详细研究。
本研究纳入了1990年至2005年间在马尔堡我们机构接受（部分）肾切除术治疗的780例患者。平均随访时间为5.44年。
780例患者中，486例（62%）为男性，294例（38%）为女性。女性年龄显著更大（平均年龄65.3岁对62.2岁；p<0.001，t检验），T分期更低（p=0.046，卡方检验），诊断时发生转移的频率更低（p=0.026，卡方检验）。此外，女性比男性更常发生透明细胞肿瘤（85.2%对78.3%），乳头状肿瘤则较少见（11.0%对18.8%）（p=0.026，卡方检验）。相比之下，男性死于RCC的风险增加（风险比1.23，95%置信区间0.92 - 1.63）；Kaplan-Meier曲线显示男性和女性的肿瘤特异性生存率存在显著差异（p=0.033，对数秩检验；5年生存率74%对83%）。然而，与肿瘤分期和肿瘤分级不同，在多变量分析中，性别不能作为一个显著的独立预后标志物保留下来。
总体而言，男性RCC的特征是肿瘤分期更高，诊断时转移更频繁，肿瘤特异性生存率更低。然而，由于性别未能作为肿瘤特异性生存的独立预后标志物，常规体检不足导致的诊断延迟和/或更具侵袭性的肿瘤生物学特性可能是并存的原因。因此，对男性进行全面的定期体检，包括肾细胞癌方面的检查，是必不可少的。
