Division of Oncology and Therapeutic Pathology, Department of Clinical Sciences, Lund University, SE-221 85, Lund, Sweden.
Division of Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden.
BMC Cancer. 2023 Apr 11;23(1):334. doi: 10.1186/s12885-023-10720-w.
Periampullary cancer is a term for cancers arising in or in close proximity to the pancreas. Pancreatic cancer is the 3 leading cause of cancer death for both sexes and while surgery is the only option for cure, chemotherapy is given in both the adjuvant and palliative settings. The aim of this study was to investigate any sex and gender differences in patients with pancreatic and other periampullary adenocarcinomas enrolled in a prospective, observational trial.
The study cohort consists of the first 100 patients, 49 women and 51 men, enrolled in the Chemotherapy, Host Response and Molecular dynamics in Periampullary cancer (CHAMP) study, an ongoing study of patients undergoing neoadjuvant, adjuvant or first-line palliative chemotherapy treatment. Twenty-five patients had surgery with curative intent and subsequent adjuvant treatment, and 75 patients were treated with palliative chemotherapy. Data regarding health-related quality of life (HRQoL, EORTC-QLQ-C30) at baseline, demographic and clinicopathological factors were examined and stratification by treatment intention according to sex. Overall survival (OS) was calculated through Kaplan-Meier analysis.
There was a statistically significant difference between male and female patients treated with curative intent, with fewer women having undergone surgery (18 vs 7, p = 0.017), also after adjustment for age, tumor location and performance status. No statistical differences were found between the sexes regarding age, comorbidities, or clinicopathological factors. Before start of chemotherapy treatment, health-related quality of life (HRQoL) was lower in female than in male patients. However, HRQoL was not associated with performance status in female patients, whereas in male patients several HRQoL indicators were significantly positively associated with poorer performance status at baseline.
This study shows no clear differences between the sexes regarding biological factors concluding that gender bias might be responsible for the discrepancy between men and women being offered curative surgery. The observed difference between women and men regarding the association between HRQoL and performance status is unprecedented. Altogether these findings underline the importance of taking gender into consideration when assessing eligibility for curative surgery in order to improve biological outcome and decrease suffering in both sexes.
NCT03724994.
壶腹周围癌是指发生在胰腺或胰腺附近的癌症。胰腺癌是男女癌症死亡的第 3 大原因，虽然手术是治愈的唯一选择，但化疗在辅助和姑息治疗中都有应用。本研究旨在调查接受新辅助、辅助或一线姑息化疗治疗的前瞻性观察性试验中纳入的胰腺和其他壶腹周围腺癌患者的任何性别和性别差异。
该研究队列包括前 100 名患者，49 名女性和 51 名男性，他们参加了正在进行的壶腹周围癌化疗、宿主反应和分子动力学（CHAMP）研究，该研究纳入了接受新辅助、辅助或一线姑息化疗治疗的患者。25 名患者有治愈意图的手术和随后的辅助治疗，75 名患者接受姑息化疗。根据治疗意图按性别分层，检查了基线时与健康相关的生活质量（HRQoL，EORTC-QLQ-C30）、人口统计学和临床病理因素的数据。通过 Kaplan-Meier 分析计算总生存期（OS）。
接受根治性治疗的男性和女性患者之间存在统计学显著差异，女性接受手术的人数较少（18 例 vs 7 例，p=0.017），即使在调整年龄、肿瘤位置和表现状态后也是如此。在年龄、合并症或临床病理因素方面，男女之间没有统计学差异。开始化疗治疗前，女性的健康相关生活质量（HRQoL）低于男性。然而，HRQoL 与女性患者的表现状态无关，而在男性患者中，几个 HRQoL 指标与基线时较差的表现状态显著正相关。
本研究表明，在生物学因素方面，男女之间没有明显差异，这表明性别偏见可能是导致男性和女性接受根治性手术的差异的原因。女性和男性之间在 HRQoL 与表现状态之间的关联方面观察到的差异是前所未有的。总之，这些发现强调了在评估接受根治性手术的资格时考虑性别的重要性，以改善两性的生物学结果并减少痛苦。
NCT03724994。
