Residual Tumour and Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France.
Department of Gynaecology, Strasbourg University Hospital, Strasbourg, France.
Br J Surg. 2024 Aug 2;111(8). doi: 10.1093/bjs/znae179.
The main objective of this study was to undertake an exhaustive investigation of sex-related differences in cancer surgery.
This observational study used data from the French national health insurance system database covering 98.8% of the population. Patients diagnosed with non-sex-specific solid invasive cancers between January 2018 and December 2019 were included. The main outcomes were likelihood of undergoing cancer surgery, type of oncological surgery performed, and associated 30-, 60-, and 90-day postoperative reoperation and mortality rates, by sex.
For the 367 887 patients included, women were 44% more likely than men to undergo cancer surgery (OR 1.44, 95% c.i. 1.31 to 1.59; P < 0.001). However, the likelihood of surgery decreased with advancing age (OR 0.98, 0.98 to 0.98; P < 0.001), and with increasing number of co-morbid conditions (OR 0.95, 0.95 to 0.96; P < 0.001), especially in women. Men had higher 90-day reoperation (21.2 versus 18.8%; P < 0.001) and mortality (1.2 versus 0.9%; P < 0.001) rates than women, overall, and for most cancer types, with the exception of bladder cancer, for which the 90-day mortality rate was higher among women (1.8 versus 1.4%; P < 0.001). After adjustment for age, number of co-morbid conditions, and surgical procedure, 90-day mortality remained higher in men (OR 1.16, 1.07 to 1.26; P < 0.001), and men were 21% more likely than women to undergo reoperation within 90 days (OR 1.21, 1.18 to 1.23; P < 0.001).
Women were much more likely than men to undergo cancer surgery than men, but the likelihood of surgery decreased with advancing age and with increasing number of co-morbid conditions, especially in women. These findings highlight a need for both increased awareness and strategies to ensure gender equality in access to oncological surgical treatment and improved outcomes.
本研究的主要目的是对癌症手术中的性别相关差异进行全面调查。
本观察性研究使用了覆盖 98.8%人口的法国国家健康保险系统数据库的数据。纳入了 2018 年 1 月至 2019 年 12 月期间诊断患有非性别特异性实体浸润性癌症的患者。主要结局为按性别划分的癌症手术可能性、实施的肿瘤手术类型，以及相关的 30、60 和 90 天术后再次手术和死亡率。
在纳入的 367887 名患者中，女性接受癌症手术的可能性比男性高 44%（OR 1.44，95%CI 1.31 至 1.59；P<0.001）。然而，手术的可能性随着年龄的增长而降低（OR 0.98，0.98 至 0.98；P<0.001），随着合并症数量的增加而降低（OR 0.95，0.95 至 0.96；P<0.001），尤其是在女性中。总体而言，男性的 90 天再手术（21.2 比 18.8%；P<0.001）和死亡率（1.2 比 0.9%；P<0.001）均高于女性，而且大多数癌症类型的情况都是如此，但膀胱癌除外，膀胱癌女性的 90 天死亡率更高（1.8 比 1.4%；P<0.001）。在调整年龄、合并症数量和手术程序后，男性的 90 天死亡率仍然较高（OR 1.16，1.07 至 1.26；P<0.001），而且男性在 90 天内再次手术的可能性比女性高 21%（OR 1.21，1.18 至 1.23；P<0.001）。
女性接受癌症手术的可能性比男性高得多，但手术的可能性随着年龄的增长和合并症数量的增加而降低，尤其是在女性中。这些发现强调了需要提高认识，并制定策略，以确保在获得肿瘤外科治疗和改善结果方面的性别平等。
