Division of Medical Oncology and Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA 90033, USA.
Clin Cancer Res. 2009 Oct 15;15(20):6391-7. doi: 10.1158/1078-0432.CCR-09-0877. Epub 2009 Sep 29.
Previous studies have shown that estrogen prevents colon cancer in postmenopausal women, indicating a role in colorectal cancer carcinogenesis and tumor progression. We investigated the interactions between sex, age, ethnicity, and year of diagnosis on overall survival (OS) in patients with metastatic colorectal cancer (MCRC).
We screened 52,882 patients with MCRC from 1988 to 2004, using the Surveillance Epidemiology and End Results registry. Age at diagnosis, sex, ethnicity, tumor location, year of diagnosis, OS, and cancer-specific survival were evaluated using Cox proportional hazards model. The models were adjusted for marital status, tumor site, tumor differentiation, and treatment with radiation and/or surgery.
We observed that younger women (18-44 years old) with MCRC lived longer than younger men (17 months versus 14; P < 0.0001, log-rank test). In contrast, older women (55 years and older) had significantly worse OS than older men (7 months versus 9; P < 0.0001, log-rank test). In multivariate analysis, we found that gender discrepancies have widened in recent years; young women diagnosed after 2000 have improved cancer-specific survival, compared to men (hazard ratio, 0.778; 95% confidence interval, 0.669-0.904), but those diagnosed before 2000 benefit less (hazard ratio, 0.931; 95% confidence interval, 0.821-1.056).
As one of the largest data sets analyzed to establish that younger women with MCRC survive longer than younger men, hormonal status not only seems to play an important role in the development and pathogenesis of colorectal cancer but also may be of prognostic significance. These data warrant further studies to determine the role of estrogen in colorectal cancer.
先前的研究表明，雌激素可预防绝经后女性的结肠癌，这表明其在结直肠癌的发生和肿瘤进展中具有一定作用。我们研究了性别、年龄、种族和诊断年份对转移性结直肠癌（MCRC）患者总生存期（OS）的相互影响。
我们利用监测、流行病学和最终结果（SEER）登记处筛选了 1988 年至 2004 年间 52882 例 MCRC 患者。使用 Cox 比例风险模型评估诊断时的年龄、性别、种族、肿瘤位置、诊断年份、OS 和癌症特异性生存。这些模型经过婚姻状况、肿瘤部位、肿瘤分化以及是否接受放疗和/或手术的调整。
我们发现，年轻的 MCRC 女性（18-44 岁）比年轻男性（17 个月对 14 个月；P<0.0001，对数秩检验）的生存期更长。相比之下，老年 MCRC 女性（55 岁及以上）的 OS 明显比老年男性差（7 个月对 9 个月；P<0.0001，对数秩检验）。多变量分析显示，近年来，性别差异有所扩大；2000 年后诊断的年轻女性的癌症特异性生存较男性改善（风险比，0.778；95%置信区间，0.669-0.904），但 2000 年前诊断的年轻女性获益较小（风险比，0.931；95%置信区间，0.821-1.056）。
作为分析以确定年轻的 MCRC 女性比年轻男性生存期更长的最大数据集之一，激素状态不仅似乎在结直肠癌的发生和发病机制中发挥重要作用，而且可能具有预后意义。这些数据需要进一步研究以确定雌激素在结直肠癌中的作用。
