Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Dis Colon Rectum. 2009 Dec;52(12):1982-91. doi: 10.1007/DCR.0b013e3181beb42a.
It has been observed that survival after colorectal cancer resection is longer in women than men. The majority of these studies are in non-U.S. populations and few use appropriate multivariate adjustment. We used the Surveillance, Epidemiology and End Results- Medicare database to examine disease-specific survival in women and men undergoing colorectal cancer resection in the United States, adjusting for patient, cancer, and hospital characteristics in an effort to identify disparities, not only in survival, but also in patterns of presentation, surgical resection, and treatment.
With use of the Surveillance, Epidemiology and End Results-Medicare-linked database, we performed a retrospective cohort study of 30,975 patients with colon cancer and 8,350 patients with rectal cancer who underwent surgical resection from 1996 to 2003. Kaplan-Meier curves, the log-rank test, and Cox regression compared survival between genders. Multivariate adjustment was performed by use of patient demographics; cancer variables including stage, medical treatment, and adequacy of nodal harvest; and hospital characteristics.
In both cancers, women presented at an older age and more emergently than men. They also underwent less aggressive medical therapy for advanced disease; in particular, in the octogenarian population. In unadjusted analysis, there was no gender difference in survival (colon hazard ratio, 0.98; P = 0.74; rectal hazard ratio, 0.95; P =0.10). After full adjustment, however, women had significantly longer survival, in particular, after rectal resection (colon hazard ratio, 0.91; P< 0.001; rectal hazard ratio, 0.82; P< 0.001).
Women in this cohort have longer adjusted survival compared with men; however, they present more emergently and at an older age, and they receive less aggressive medical treatment. These are noticeable disparities that could serve as targets for continued improvement.
已经观察到，女性结直肠癌手术后的存活率高于男性。这些研究大多来自非美国人群，而且很少使用适当的多变量调整。我们使用监测、流行病学和最终结果-医疗保险数据库，在美国检查接受结直肠癌切除术的女性和男性的疾病特异性存活率，调整患者、癌症和医院特征，以努力确定差异，不仅在存活率方面，而且在表现、手术切除和治疗模式方面。
利用监测、流行病学和最终结果-医疗保险数据库，我们对 1996 年至 2003 年间接受手术切除的 30975 例结肠癌患者和 8350 例直肠癌患者进行了回顾性队列研究。使用 Kaplan-Meier 曲线、对数秩检验和 Cox 回归比较了性别间的存活率。通过使用患者人口统计学数据、癌症变量（包括分期、治疗和淋巴结采集的充分性）和医院特征进行多变量调整。
在两种癌症中，女性的发病年龄比男性更大，更紧急。她们还接受了针对晚期疾病的侵袭性较小的药物治疗；特别是在 80 岁以上的人群中。在未调整的分析中，生存率没有性别差异（结肠癌风险比，0.98；P=0.74；直肠癌风险比，0.95；P=0.10）。然而，在充分调整后，女性的生存率显著延长，特别是在接受直肠切除术的情况下（结肠癌风险比，0.91；P<0.001；直肠癌风险比，0.82；P<0.001）。
在这个队列中，女性的调整后存活率高于男性；然而，她们的发病更紧急，年龄更大，并且接受的药物治疗不那么积极。这些是明显的差异，可能成为持续改进的目标。
