Female sex is associated with a lower risk of bone metastases and favourable prognosis in non-sex-specific cancers

Ma, Wenjuan; Peltzer, Karl; Qi, Lisha; Xu, Ge‐Liang; Liu, Zheng; Wang, Jingyi; Mao, Min; Чехонин, В. П.; Wang, Xin; Zhang, Chao

doi:10.1186/s12885-019-6168-1

Cited by 11 publications

(12 citation statements)

References 35 publications

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“…Under these hypoxic conditions, tumor cells can switch to collecting unsaturated fatty acids from the microenvironment ( 9 ), and it could be proposed that, although highly speculative, the increased unsaturated fatty acids we show within the spine and pelvis compared to the femora and tibia might be a part of the explanation why skeletal metastases are preferentially located within the axial skeleton ( 55 ). Furthermore, it could be postulated, again highly speculatively, that the gender-associated differences in BMAT within the spine, pelvis, and proximal femur, i.e., areas containing red bone marrow, could be part of the explanation for the observation that female patients are less likely to have skeletal metastasis ( 56 ) and more likely to develop osteoporosis. Future research on the interaction between BMAT and bone metabolism or skeletal metastasis should take these differences between the axial and appendicular skeleton into consideration, as results on BMAT acquired from the iliac crest might provide different results compared to BMAT acquired from the proximal femur.…”

Section: Discussionmentioning

confidence: 99%

Gender- and Age-Associated Differences in Bone Marrow Adipose Tissue and Bone Marrow Fat Unsaturation Throughout the Skeleton, Quantified Using Chemical Shift Encoding-Based Water–Fat MRI

et al. 2022

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Bone marrow adipose tissue (BMAT) is a dynamic tissue which is associated with osteoporosis, bone metastasis, and primary bone tumors. The aim of this study is to determine region-specific variations and age- and gender-specific differences in BMAT and BMAT composition in healthy subjects. In this cross-sectional study, we included 40 healthy subjects (26 male: mean age 49 years, range 22–75 years; 14 female: mean age 50 years, range 29–71) and determined the bone marrow signal fat fraction and bone marrow unsaturation in the spine (C3-L5), pelvis, femora, and tibiae using chemical shift encoding-based water–fat imaging (WFI) with multiple gradient echoes (mGRE). Regions of interest covered the individual vertebral bodies, pelvis and proximal epimetaphysis, diaphysis, and distal epimetaphysis of the femur and tibia. The spinal fat fraction increased from cervical to lumbar vertebral bodies (mean fat fraction ( ± SD or (IQR): cervical spine 0.37 ± 0.1; thoracic spine 0.41 ± 0.08. lumbar spine 0.46 ± 0.01; p < 0.001). The femoral fat fraction increased from proximal to distal (proximal 0.78 ± 0.09; diaphysis 0.86 (0.15); distal 0.93 ± 0.02; p < 0.001), while within the tibia the fat fraction decreased from proximal to distal (proximal 0.92 ± 0.01; diaphysis 0.91 (0.02); distal 0.90 ± 0.01; p < 0.001). In female subjects, age was associated with fat fraction in the spine, pelvis, and proximal femur (ρ = 0.88 p < 0.001; ρ = 0.87 p < 0.001; ρ = 0.63 p = 0.02; ρ = 0.74 p = 0.002, respectively), while in male subjects age was only associated with spinal fat fraction (ρ = 0.40 p = 0.04). Fat fraction and unsaturation were negatively associated within the spine (r = -0.40 p = 0.01), while in the extremities fat fraction and unsaturation were positively associated (distal femur: r = 0.42 p = 0.01; proximal tibia: r = 0.47, p = 0.002; distal tibia: r = 0.35 p = 0.03), both independent of age and gender. In conclusion, we confirm the distinct, age- and gender-dependent, distribution of BMAT throughout the human skeleton and we show that, contradicting previous animal studies, bone marrow unsaturation in human subjects is highest within the axial skeleton compared to the appendicular skeleton. Furthermore, we show that BMAT unsaturation was negatively correlated with BMAT within the spine, while in the appendicular skeleton, BMAT and BMAT unsaturation were positively associated.

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Section: Discussionmentioning

confidence: 99%

Gender- and Age-Associated Differences in Bone Marrow Adipose Tissue and Bone Marrow Fat Unsaturation Throughout the Skeleton, Quantified Using Chemical Shift Encoding-Based Water–Fat MRI

et al. 2022

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“…[ 20 ] Ma et al reported that female sex was associated with a lower risk of bone metastasis in digestive system cancers. [ 21 ] Sex hormone levels differ between men and women, and musculoskeletal health may be the primary cause of these differences. [ 22 ] Differences in lifestyle factors may also account for these outcomes; for example, men are 1.5-times more likely than women to smoke.…”

Section: Discussionmentioning

confidence: 99%

Metastasis pattern and prognosis in men with esophageal cancer patients

et al. 2021

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Esophageal cancer (EC) is relatively common; at the time of diagnosis, 50% of cases present with distant metastases, and most patients are men. This study aimed to examine and compare the clinicopathological characteristics and metastatic patterns of male EC (MEC) and female EC (FEC). In addition, risk factors associated with MEC prognosis were evaluated. The present study population was extracted from the Surveillance Epidemiology and End Results database. MEC characteristics and factors associated with prognosis were evaluated using descriptive analysis, the Kaplan–Meier method, and the Cox regression model. A total of 12,558 MEC cases were included; among them, 3454 cases had distant organ metastases. Overall, 27.5% of the entire cohort were patients with distant organ metastases. Compared with patients with non-metastatic MEC, patients with metastatic MEC were more likely to be aged ≤60 years, of Black and White race, have a primary lesion in the overlapping esophagus segments, and have a diagnosis of adenocarcinoma of poorly differentiated and undifferentiated grade that was treated with radiotherapy and chemotherapy rather than surgery; moreover, they were also more likely to be married and insured. In addition, patients with MEC were more likely to be aged ≤60 years, White race, and diagnosed with a primary lesion in the lower third of the esophagus and overlapping esophagus segments, and treated without chemotherapy, compared with those with FEC. Patients in the former group were also more likely than those in the latter group to be unmarried and have bone metastasis only and lung metastasis only. Liver, lung, and bone metastases separately, and simultaneous liver and lung metastases were associated with poor survival in MEC patients. Metastatic MEC is associated with clinicopathological characteristics and metastatic patterns different from those associated with non-metastatic MEC and metastatic FEC. Metastatic MEC and FEC patients may have similar prognoses. Distant organ metastasis may be associated with poor prognosis in patients with MEC and FEC.

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“…The dots represent outliers with poorer MFS in our study cohort. In a recent study, female sex was proposed to be associated with a lower risk of BM [41]. This prognostic factor was also found to be relevant by Zhang et al, who included these factors in a predictive scoring system [42].…”

Section: Bone Metastasis-free Survivalmentioning

confidence: 81%

Clinicopathologic characteristics, metastasis-free survival, and skeletal-related events in 628 patients with skeletal metastases in a tertiary orthopedic and trauma center

et al. 2021

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Background Skeletal-related events (SREs) due to bone metastases (BM) significantly impact the morbidity and mortality of cancer patients. The present study sought to investigate clinicopathological characteristics, metastasis-free survival (MFS), and SREs in patients referred to a tertiary orthopedic and trauma center. Methods Data were retrieved from electronic health records (n=628). Survival curves were estimated utilizing the Kaplan–Meier method. The Cox regression model was used to determine factors influencing MFS based on estimated hazard ratios (HRs). Results Breast (55.8%) and lung (18.2%), and lung (32.9%) and prostate (16.8%) cancer were the most common cancer types in our cohort in women and men, respectively. Fifteen percent of patients presented with BM as the first manifestation of tumor disease, 23% had metastasis diagnosis on the same day of primary tumor diagnosis or within 3 months, and 62% developed BM at least 3 months after primary tumor diagnosis. Osteolytic BM were predominant (72.3%) and most commonly affecting the spine (23%). Overall median MFS was 45 months (32 (men) vs. 53 (women) months). MFS was shortest in the lung (median 15 months, 95% CI 8.05–19) and longest in breast cancer (median 82 months, 95% CI 65.29–94). Age (≥ 60 vs. < 60 years) and primary cancer grading of ≥2 vs. 1 revealed prognostic relevance. Conclusion Women with breast or lung cancer, men with lung or prostate cancer, age ≥60 years, male sex, and primary cancer grading ≥2 are associated with increased risk for MBD. Intensified follow-up programs may reduce the risk of SREs and associated morbidity and mortality.

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Female sex is associated with a lower risk of bone metastases and favourable prognosis in non-sex-specific cancers

Cited by 11 publications

References 35 publications

Gender- and Age-Associated Differences in Bone Marrow Adipose Tissue and Bone Marrow Fat Unsaturation Throughout the Skeleton, Quantified Using Chemical Shift Encoding-Based Water–Fat MRI

Gender- and Age-Associated Differences in Bone Marrow Adipose Tissue and Bone Marrow Fat Unsaturation Throughout the Skeleton, Quantified Using Chemical Shift Encoding-Based Water–Fat MRI

Metastasis pattern and prognosis in men with esophageal cancer patients

Clinicopathologic characteristics, metastasis-free survival, and skeletal-related events in 628 patients with skeletal metastases in a tertiary orthopedic and trauma center

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