Gender comparison of clinical, histopathological, therapeutic and outcome factors in 185,967 colon cancer patients

Abstract

Introduction Colorectal carcinomas represent the third most common cause of cancer-related deaths in Germany. Although the incidence is significantly higher in men compared with women and gender is a well-established crucial factor for outcome in other diseases, detailed gender comparisons for colon cancer are lacking. Methods This retrospective population-based cohort study included all patients diagnosed with colon cancer in Germany between 2000 and 2016 who were included in the common dataset of colorectal cancer patients from the quality conference of the German Cancer Society. We compared clinical, histopathological, and therapeutic characteristics as well as overall and recurrence-free survival. Results A total of 185,967 patients were included in the study, of which 85,685 were female (46.1%) and 100,282 were male (53.9%). The proportion of women diagnosed with colon cancer decreased from 2000 to 2016 (f: 26.6 to 40.1%; m: 24.9 to 41.9%; p < 0.001), and the proportion of very old patients was especially high in women (f: 27.3%; m: 15.6%; p < 0.001). The localization in women was more right-sided (f: 45.0%, m: 36.7%; p < 0.001), and women had a higher tumor grading and a higher UICC stage (especially stage III nodal-positive) at diagnosis of primary colon cancer (UICC III: f: 22.7%, m: 21.0%; p < 0.001). We could detect a significantly better overall (hazard ratio: 0.853, lower 95%: 0.841, upper 95%: 0.864; p < 0.001) and recurrence-free survival (hazard ratio: 0.857, lower 95%: 0.845, upper 95%: 0.868; p < 0.001) in women compared with men, even though women received chemotherapy less frequently compared with men (f: 26.1%, m: 28.1%; p < 0.001). Highlights • Women are older than men at diagnosis of primary colon cancer • The localization in women tends to be right-sided, and women tend to have a higher tumor grading and a higher UICC stage (especially stage III nodal-positive) • Women show a better overall and recurrence-free survival compared with men • Women receive chemotherapy less frequently than men do Electronic supplementary material The online version of this article (

A Review of Colorectal Cancer in Terms of Epidemiology, Risk Factors, Development, Symptoms and Diagnosis

“…In addition, men who are diagnosed with colorectal cancer have a worse prognosis and approximately 40% higher mortality compared to women [ 17 ]. On the other hand, women are more prone to develop right-sided colon cancer, which is often diagnosed at a more advanced stage and seemed more aggressive than left-sided tumors [ 64 , 65 ]. The reasons for sex disparity are not fully understood, it is considered that they may be related to the differences in the exposure to risk factors (e.g., alcohol and tobacco), dietary patterns and sex hormones [ 17 , 47 ].…”

Sexual Dimorphism in Colon Cancer

“…Several retrospective studies have shown female CRC patients to have longer survival rates than male patients. For example, a German population-based cohort study including 185,967 patients showed women had significantly better overall (HR 0.853) and recurrence-free survival (HR 0.857) than men ( 10 ). A meta-analysis from 2017 including 37 clinical trials determined that women had better overall (HR 0.87) and cancer-specific survival (HR 0.92) than men ( 11 ).…”

Prognostic Nomograms for Predicting Overall Survival and Cancer-Specific Survival of Patients With Early Onset Colon Adenocarcinoma

“…Moreover, a recent study has indicated that the tumor deposits to be associated with negative prognostic effect, especially in stage IIIB colon cancer, with a 3.2-fold increased risk of disease recurrence (12). Also, female patients with colorectal cancer showed a slight but significantly better OS than men (13). Similarly, a meta-analysis by Yang et al confirmed this finding when comparing nine studies (14).…”