Seeland U, Heger U, Heise K, Ott K
Institut für Geschlechterforschung in der Medizin (GiM), Charité - Universitätsmedizin Berlin, Deutschland.
Allgemein-, Viszeral- und Transplantationschirurgie, Chirurgische Universitätsklinik Heidelberg, Deutschland.
Zentralbl Chir. 2015 Jun;140(3):266-72. doi: 10.1055/s-0035-1545963. Epub 2015 Jun 26.
Systematic analyses of gender effects in gastrointestinal malignancies are currently lacking, partly because sex and gender have not been used as stratification criteria in major studies on the topic. It is, however, indisputable that gastrointestinal tumours differ in risk factors, incidence and prognosis between the genders. This review summarises the most important findings on differences related to biological sex and sociocultural gender and discusses anatomic specifics with immediate significance for surgical interventions. Epidemiological differences in upper gastrointestinal malignancies are most prominent in regard to histological subtypes, directly affecting diagnostics, therapy, and prognosis. Women have a better prognosis in many of these tumour subtypes. For colorectal carcinoma, sex hormones, specifically oestrogens, appear to play a distinct role in tumourigenesis. Histopathological analysis of the expression of oestrogen receptor beta (ERβ) in the tumour tissue has attracted interest since it was shown that women with low ERβ expression have a better prognosis than men with comparable ERβ status. Data on the higher incidence of right-sided colon carcinoma and non-polypoid neoplasms in women could lead to improved screening programmes. Men and women cite differing reasons for avoidance of screening colonoscopies, thus gender specific approaches could improve colon cancer prevention programmes. Data on differing bioavailability of 5-fluorouracil between the genders are useful to minimise adverse effects of chemotherapy and should be accounted for in dosage. Further systematic analysis of gender effects on gastrointestinal tumours is warranted and would be a substantial step towards personalised oncological surgery.
目前缺乏对胃肠道恶性肿瘤性别效应的系统分析，部分原因是在该主题的主要研究中，性别未被用作分层标准。然而，无可争议的是，胃肠道肿瘤在性别之间的危险因素、发病率和预后方面存在差异。本综述总结了与生物性别和社会文化性别相关差异的最重要发现，并讨论了对手术干预具有直接意义的解剖学细节。上消化道恶性肿瘤的流行病学差异在组织学亚型方面最为突出，直接影响诊断、治疗和预后。在许多这些肿瘤亚型中，女性的预后较好。对于结直肠癌，性激素，特别是雌激素，似乎在肿瘤发生中起独特作用。自发现肿瘤组织中雌激素受体β（ERβ）表达较低的女性比具有可比ERβ状态的男性预后更好以来，对肿瘤组织中ERβ表达的组织病理学分析引起了关注。关于女性右侧结肠癌和非息肉样肿瘤发病率较高的数据可能会改进筛查方案。男性和女性避免进行结肠镜筛查的原因不同，因此针对性别的方法可以改善结肠癌预防方案。关于两性之间5-氟尿嘧啶生物利用度不同的数据有助于将化疗的不良反应降至最低，并且在剂量计算中应予以考虑。有必要对性别对胃肠道肿瘤的影响进行进一步系统分析，这将是迈向个性化肿瘤手术的重要一步。
