骨肿瘤患者生存的性别差异：一项基于国家癌症数据库的分析（2004-2016）

Sex differences in osteosarcoma survival across the age spectrum: A National Cancer Database analysis (2004-2016).

机构信息

Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.

Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.

出版信息

Cancer Epidemiol. 2024 Oct;92:102565. doi: 10.1016/j.canep.2024.102565. Epub 2024 Apr 4.

DOI:10.1016/j.canep.2024.102565

PMID:38575425

Abstract

BACKGROUND

Osteosarcoma displays a bimodal peak in incidence in adolescence and later adulthood. Males are more frequently diagnosed with osteosarcoma in both periods. Males have worse survival than females, which is generally poor at 30-70% 5-years post diagnosis, depending on age, but treatment received is often unaccounted for in survival analyses.

METHODS

Therefore, we estimated sex differences in survival for children and adults stratifying by treatment received and other disease characteristics using the National Cancer Database (2004-2016, n=9017). We estimated sex differences in long-term survival using Kaplan Meier survival curves and Log-Rank p-values. We also estimated hazard ratios (HR) and 95% confidence intervals (CIs) as the measure of association between sex and death using Cox regression.

RESULTS

In all age groups, cases were predominantly male (52-58%). In Kaplan-Meier analyses, males had worse overall survival than females for 0-19, 20-39, and ≥60-year-olds (Log-Rank p<0.05). Females had higher 5- and 10-year survival percentages in all age groups. In adjusted Cox models, males had a higher risk of death among 0-19-year-olds (HR: 1.24, 95% CI: 1.06-1.44; HR: 1.35, 95% CI: 1.12, 1.63, HR: 1.31, 95% CI: 1.09-1.59). Among 20-39-year-olds, males had an increased risk of death when receiving surgery only (HR: 4.67, 95% CI: 1.44, 15.09). Among those ≥60-year-olds, males had a suggestive increased risk of death overall (HR: 1.17, 95% CI: 0.99-1.39) and a higher risk of death based on some tumor locations, (HR: 2.52, 95% CI: 1.24, 5.11; HR: 1.36, 95% CI: 1.02, 1.82).

CONCLUSIONS

Our findings suggest that the worse survival among young males compared to females with osteosarcoma persisted after accounting for many major disease characteristics, including treatment received. Collectively, our work points toward other unexplored mechanisms beyond treatment, potentially biologic or otherwise, which may be driving the observed sex differences in long-term survival.

摘要

背景

骨肉瘤在青少年和成年后期呈现双峰发病高峰。男性在这两个时期都更常被诊断出患有骨肉瘤。男性的生存率比女性差，一般在诊断后 30-70%的 5 年内，具体取决于年龄，但治疗方法通常在生存分析中没有得到考虑。

方法

因此，我们使用国家癌症数据库（2004-2016 年，n=9017），根据接受的治疗和其他疾病特征，对儿童和成人的生存情况进行了性别差异分析。我们使用 Kaplan-Meier 生存曲线和 Log-Rank p 值估计了长期生存的性别差异。我们还使用 Cox 回归估计了性别与死亡之间的关联的风险比（HR）和 95%置信区间（CI）。

结果

在所有年龄组中，病例主要为男性（52-58%）。在 Kaplan-Meier 分析中，0-19 岁、20-39 岁和≥60 岁的男性总体生存率均低于女性（Log-Rank p<0.05）。女性在所有年龄组中的 5 年和 10 年生存率百分比都较高。在调整后的 Cox 模型中，0-19 岁的男性死亡风险更高（HR：1.24，95%CI：1.06-1.44；HR：1.35，95%CI：1.12-1.63；HR：1.31，95%CI：1.09-1.59）。20-39 岁的男性仅接受手术治疗时死亡风险增加（HR：4.67，95%CI：1.44-15.09）。≥60 岁的男性总体死亡风险增加（HR：1.17，95%CI：0.99-1.39），且某些肿瘤部位的死亡风险更高（HR：2.52，95%CI：1.24-5.11；HR：1.36，95%CI：1.02-1.82）。