Zaitsu Masayoshi, Toyokawa Satoshi, Takeuchi Takumi, Kobayashi Yasuki, Kawachi Ichiro
Department of Public Health, Graduate School of Medicine The University of Tokyo Tokyo Japan.
Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health Boston Massachusetts.
Health Sci Rep. 2019 Dec 20;3(1):e142. doi: 10.1002/hsr2.142. eCollection 2020 Mar.
In Western countries, sex differences in renal cell carcinoma (RCC) histology and survival have been previously described: compared with men, clear cell subtype is more common but overall prognosis is better among women. The goal of the present study was to examine sex differences in RCC histology and survival in Japan, using a large-scale population-based data set.
With the use of a population-based cancer registry in Japan (2004-2016), patients with primary RCC were followed for 5 years (median follow-up time 2.1 years). We distinguished histological subtypes of clear cell, papillary, and chromophobe from "others" subtype. Sex-specific prevalence ratio (PR) for each histological subtype was estimated by Poisson regression with robust variance, adjusted for age and year of diagnosis. Sex-specific survival rates were estimated by Cox proportional hazard regression, adjusted for age, year of diagnosis, histological subtypes, and other prognostic variables, with multiple imputation.
The prevalence of clear cell and "others" subtypes was similar between men and women among all the 5265 study subjects during the 12 years of study (clear cell, male 88.6% vs female 87.1%; "others", male 5.3% vs female 5.3%). However, papillary subtype was less common among women than men (male 4.6% vs female 2.8%; PR = 0.63; 95% CI, 0.45-0.88), while chromophobe subtype was more common among women (male 1.6% vs female 4.8%; PR = 3.18; 95% CI, 2.26-4.47). Although "others" subtype (but not papillary/chromophobe subtypes) independently predicted prognosis (HR = 1.74; 95% CI, 1.32-2.30), no sex differences were observed in RCC survival.
We did not observe a statistically significant difference in the prevalence of clear cell subtype between men and women in Japan, which differs from the pattern previously described in Western countries. Sex differences in RCC histology may not affect RCC survival in this population.
在西方国家，先前已描述过肾细胞癌（RCC）组织学和生存率方面的性别差异：与男性相比，透明细胞亚型更为常见，但女性的总体预后更好。本研究的目的是利用大规模基于人群的数据集，研究日本RCC组织学和生存率方面的性别差异。
利用日本基于人群的癌症登记处（2004 - 2016年）的数据，对原发性RCC患者进行了5年随访（中位随访时间2.1年）。我们将透明细胞、乳头状和嫌色细胞的组织学亚型与“其他”亚型区分开来。通过泊松回归并采用稳健方差估计各组织学亚型的性别特异性患病率比（PR），并对年龄和诊断年份进行了调整。通过Cox比例风险回归估计性别特异性生存率，并对年龄、诊断年份、组织学亚型和其他预后变量进行了调整，采用多重填补法。
在12年的研究期间，所有5265名研究对象中，男性和女性的透明细胞和“其他”亚型患病率相似（透明细胞，男性88.6% vs女性87.1%；“其他”，男性5.3% vs女性5.3%）。然而，乳头状亚型在女性中比男性少见（男性4.6% vs女性2.8%；PR = 0.63；95% CI，0.45 - 0.88），而嫌色细胞亚型在女性中更为常见（男性1.6% vs女性4.8%；PR = 3.18；95% CI，2.26 - 4.47）。尽管“其他”亚型（而非乳头状/嫌色细胞亚型）独立预测预后（HR = 1.74；95% CI，1.32 - 2.30），但在RCC生存率方面未观察到性别差异。
我们在日本未观察到男性和女性在透明细胞亚型患病率上有统计学显著差异，这与西方国家先前描述的模式不同。RCC组织学上的性别差异可能不会影响该人群的RCC生存率。
