Katzenstein J, Steinert R, Ptok H, Otto R, Gastinger I, Lippert H, Meyer F
AN-Institut für Qualitätssicherung, Otto-von-Guericke-Universität, Magdeburg, Deutschland.
Klinik für Allgemein- und Viszeralchirurgie, AMEOS-Klinikum Aschersleben, Aschersleben, Deutschland.
Chirurg. 2018 Jun;89(6):458-465. doi: 10.1007/s00104-018-0634-1.
Gender-specific aspects have been increasingly considered in clinical medicine, also in oncological surgery.
To analyze gender-specific differences of early postoperative and oncological outcomes after rectal cancer resection based on data obtained in a prospective multicenter observational study.
As part of the multicenter prospective observational study "Quality assurance in primary rectal cancer", data on tumor site, exogenic and endogenic risk factors, neoadjuvant treatment, surgical procedures, tumor stage, intraoperative and postoperative complications of patients with the histological diagnosis of rectal cancer were registered. Data from the years 2005-2006 and 2010-2011 were investigated with respect to gender-specific differences of postoperative morbidity, hospital mortality, local recurrency rate, disease-free and overall survival by univariable and multivariable analyses.
Overall, data from 10,657 patients were evaluated: 60.9% of the patients were male, who were significantly younger (p < 0.001). Men had a significantly higher rate of alcohol (p < 0.001) and nicotine abuse (p < 0.001) as well as a trend to a higher body mass index (BMI) compared with women. Although, there was no significant difference in the distribution of various tumor stages comparing men and women, neoadjuvant radiochemotherapy was used significantly more often in male patients (p < 0.001). In addition, male patients underwent an abdominoperineal rectum exstirpation more often, whereas creation of an enterostoma and Hartmann's procedure were more frequently used in women (p < 0.001 each). Multivariate analysis revealed that male patients developed a higher overall morbidity (odds ratio, OR: 1.5; p < 0.001) during both study periods and from 2010-2011 a higher hospital mortality (OR: 1.8; p < 0.001). After a median follow-up period of 36 months, gender did not have a significant impact on overall survival, disease-free survival or on the local tumor recurrency. The 5‑year overall survival was 60.5%, disease-free survival 63.8% and local recurrency rate was 5%.
Independent of other variables, gender differences were found with respect to early postoperative outcome but not to oncological long-term results after surgery of rectal cancer.
临床医学中，包括肿瘤外科手术，越来越多地考虑性别特异性因素。
基于一项前瞻性多中心观察性研究的数据，分析直肠癌切除术后早期术后及肿瘤学结局的性别差异。
作为多中心前瞻性观察性研究“原发性直肠癌质量保证”的一部分，记录了组织学诊断为直肠癌患者的肿瘤部位、外源性和内源性危险因素、新辅助治疗、手术方式、肿瘤分期、术中及术后并发症等数据。通过单变量和多变量分析，研究了2005 - 2006年和2010 - 2011年的数据，以探讨术后发病率、医院死亡率、局部复发率、无病生存率和总生存率的性别差异。
总体上，评估了10657例患者的数据：60.9%的患者为男性，男性患者明显更年轻（p < 0.001）。与女性相比，男性酒精滥用（p < 0.001）和尼古丁滥用率显著更高（p < 0.001），且体重指数（BMI）有升高趋势。尽管男性和女性在各肿瘤分期的分布上无显著差异，但男性患者新辅助放化疗的使用频率显著更高（p < 0.001）。此外，男性患者更常接受腹会阴直肠切除术，而女性更常采用肠造口术和哈特曼手术（各p < 0.001）。多变量分析显示，在两个研究期间，男性患者的总体发病率更高（比值比，OR：1.5；p < 0.001），2010 - 2011年医院死亡率更高（OR：1.8；p < 0.001）。中位随访期36个月后，性别对总生存率、无病生存率或局部肿瘤复发无显著影响。5年总生存率为60.5%，无病生存率为63.8%，局部复发率为5%。
独立于其他变量，直肠癌手术后早期术后结局存在性别差异，但肿瘤学长期结果无性别差异。
