Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.
Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
Clin Colorectal Cancer. 2018 Dec;17(4):e711-e717. doi: 10.1016/j.clcc.2018.07.006. Epub 2018 Jul 21.
Women have been shown to experience longer overall survival after colorectal cancer (CRC) diagnosis than men even after adjusting for disease stage and management. However, the etiology of this observation is not well understood, and the impact of non-CRC health conditions on survival has not been described. We aimed to evaluate the prognostic role of sex on CRC-specific outcomes.
All patients who underwent primary resection of stage I to III CRC from 2001 to 2005, and who were referred to cancer centers in a large, representative Canadian province were reviewed. Baseline patient characteristics, including common comorbidities, were compared between men and women. Multivariable analysis was used to evaluate the associations between sex and survival outcomes.
We identified 1837 patients. Median age was 69 (interquartile range 60-76) years, and there were 867 women (47%) and 970 men (53%). Men were more likely to report ischemic heart disease, diabetes, dyslipidemia, and obesity (all P < .001). On multivariable analysis, men had worse overall and recurrence-free survival compared to women (hazard ratio [HR] = 1.38, 95% confidence interval [CI] 1.15-1.64; and HR = 1.40, 95% CI, 1.18-1.67, respectively). However, CRC-specific outcomes, including CRC-specific survival and time to recurrence, did not differ significantly between men and women (HR = 1.15, 95% CI, 0.91-1.45; and HR = 1.12, 95% CI, 0.90-1.40, respectively).
Women diagnosed with early stage CRC lived longer and had better general health than men. When noncancer causes of death were excluded, however, the trajectory of CRC appeared similar irrespective of sex. Early identification and better management of comorbidities may narrow the survival gap between men and women.
即使在调整了疾病阶段和治疗管理后，女性在结直肠癌（CRC）诊断后的总体生存时间也比男性长。然而，这种观察结果的病因尚不清楚，非 CRC 健康状况对生存的影响也尚未描述。我们旨在评估性别对 CRC 特异性结局的预后作用。
回顾了 2001 年至 2005 年间在加拿大一个代表性大省的癌症中心接受 I 期至 III 期 CRC 原发切除术的所有患者。比较了男性和女性之间的基线患者特征，包括常见合并症。多变量分析用于评估性别与生存结局之间的关联。
我们确定了 1837 名患者。中位年龄为 69 岁（四分位距 60-76 岁），其中 867 名女性（47%）和 970 名男性（53%）。男性更有可能报告缺血性心脏病、糖尿病、血脂异常和肥胖（均 P<.001）。多变量分析显示，与女性相比，男性的总体生存和无复发生存率更差（风险比[HR] 分别为 1.38、95%置信区间[CI] 1.15-1.64 和 1.40、95% CI 1.18-1.67）。然而，男性和女性之间的 CRC 特异性结局（包括 CRC 特异性生存率和复发时间）没有显著差异（HR 分别为 1.15、95% CI 0.91-1.45 和 1.12、95% CI 0.90-1.40）。
诊断为早期 CRC 的女性比男性寿命更长，整体健康状况更好。然而，当排除非癌症死亡原因时，CRC 的轨迹无论性别如何都相似。早期识别和更好地管理合并症可能会缩小男性和女性之间的生存差距。
