Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands.
Cancer Epidemiol. 2023 Oct;86:102441. doi: 10.1016/j.canep.2023.102441. Epub 2023 Aug 24.
The importance of sex and gender as modifiers of health and disease is increasingly recognized. The aim of this study was to analyze gender differences in incidence, tumor characteristics, treatment and relative survival (RS) in colorectal cancer (CRC).
Observational population-based study including patients diagnosed with CRC in the Netherlands between 2010 and 2020. Stratified by localization (colon/rectum) and age (18-55/56-70/≥71years), gender differences in incidence, tumor characteristics, treatment and RS were analyzed. Multivariable regression was used to analyze the influence of gender on treatment and RS.
The age-standardized incidence per 100,000 person-years of colon and rectal cancer is higher among men than women (colon: 41.2 versus 32.4, rectum: 22.8 versus 12.6). Besides differences in patient- and tumor characteristics, differences in treatment allocation and RS were observed. Most strikingly, women aged ≥ 71 years with stage IV colon cancer are less often treated with systemic therapy (31.3 % versus 28.4 %, adjusted odds ratio (OR) 0.63, 95 % CI 0.48-0.83) and more often receive best supportive care only (47.6 % versus 40.0 %, adjusted OR 1.58, 95 % CI 1.19-2.11).
Statistically significant and clinically relevant gender differences in incidence, patient- and tumor characteristics and treatment allocation are observed in patients with CRC. Reasons for differences in treatment allocation deserve further investigation.
性别作为健康和疾病的修饰因子的重要性日益得到认识。本研究旨在分析结直肠癌（CRC）发病、肿瘤特征、治疗和相对生存率（RS）中的性别差异。
这是一项观察性基于人群的研究，纳入 2010 年至 2020 年间在荷兰诊断为 CRC 的患者。按部位（结肠/直肠）和年龄（18-55/56-70/≥71 岁）分层，分析发病率、肿瘤特征、治疗和 RS 中的性别差异。采用多变量回归分析性别对治疗和 RS 的影响。
男性结肠和直肠癌的标准化发病率（每 10 万人年）高于女性（结肠：41.2 比 32.4；直肠：22.8 比 12.6）。除了患者和肿瘤特征的差异外，还观察到治疗分配和 RS 的差异。最显著的是，年龄≥71 岁的 IV 期结肠癌女性接受系统治疗的比例较低（31.3%比 28.4%，调整后的优势比[OR]0.63，95%置信区间[CI]0.48-0.83），而更多地接受最佳支持治疗（47.6%比 40.0%，调整后的 OR 1.58，95%CI 1.19-2.11）。
在 CRC 患者中观察到发病率、患者和肿瘤特征以及治疗分配方面存在统计学显著和临床相关的性别差异。需要进一步研究治疗分配差异的原因。
