Sato Naomi, Ito Yuri, Ioka Akiko, Tanaka Masahiro, Tsukuma Hideaki
Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Jpn J Clin Oncol. 2009 Oct;39(10):690-4. doi: 10.1093/jjco/hyp084. Epub 2009 Aug 17.
Relative 5-year survival for stomach cancer has increased gradually in Osaka for more than two decades, while women show a small but consistently lower survival for it. We analyzed gender differences in stomach cancer survival, using relative survival model proposed by Dickman et al. Study subjects were reported stomach cancer cases diagnosed in 1975-99. We estimated the excess hazard ratios (EHRs) of death using Poisson's regression model. The crude EHR for women was 1.12 [95% confidence interval (CI): 1.09-1.14] in comparison with men. After adjustments for year and age at diagnosis, the EHR for women decreased to 1.07 (95% CI: 1.05-1.09), and furthermore, it reached to an insignificant level of 1.02 (95% CI: 0.99-1.04) after an additional adjustment for the extent of disease (localized, regional, distant and unknown). With further adjustments by histological type (intestinal, diffuse and others/unknown), method of detection (screening or not) and treatment (surgery or not), the EHR decreased to 0.97 (95% CI: 0.94-0.99), significantly lower than the unity. These results indicate that the lower stomach cancer survival among women was attributable mainly to more advanced stages among women. The survival for women would have been a little better than for men if prognostic factors for stomach cancer had been comparable between the sexes. Inequality by the gender in taking screening, medical examination or treatment for stomach cancer was suggested to exist in Osaka, Japan.
二十多年来，大阪胃癌患者的相对5年生存率逐渐上升，然而女性患者的生存率虽低但始终保持在一个较小的差距。我们采用迪克曼等人提出的相对生存模型，分析了胃癌生存率的性别差异。研究对象为1975 - 1999年报告的胃癌确诊病例。我们使用泊松回归模型估计死亡的超额风险比（EHRs）。与男性相比，女性的粗EHR为1.12[95%置信区间（CI）：1.09 - 1.14]。在对诊断年份和年龄进行调整后，女性的EHR降至1.07（95% CI：1.05 - 1.09），此外，在对疾病范围（局限、区域、远处和未知）进行额外调整后，EHR降至无统计学意义的1.02（95% CI：0.99 - 1.04）。通过组织学类型（肠型、弥漫型和其他/未知）、检测方法（是否筛查）和治疗（是否手术）进一步调整后，EHR降至0.97（95% CI：0.94 - 0.99），显著低于1。这些结果表明，女性胃癌生存率较低主要归因于女性患者的病情更严重。如果胃癌的预后因素在两性之间具有可比性，女性的生存率可能会比男性略高。这表明在日本大阪，胃癌筛查、体检或治疗方面存在性别不平等现象。
