Influence of Sex and Age on Site of Onset, Morphology, and Site of Metastasis in Colorectal Cancer: A Population-Based Study on Data from Four Italian Cancer Registries

Abstract

The prognosis of colorectal cancer is affected by factors such as site of origin, tumor morphology, and metastasis at diagnosis, but also age and sex seem to play a role. This study aimed to investigate within the Italian population how sex and age interact in influencing certain aspects of the disease and how they affect patient survival, particularly in the metastatic cohort. Data from four cancer registries were collected, and patients were classified by sex and age (<50, 50–69, and >69 years). Two separate analyses were conducted: one for patients having right or left colon cancer with adenocarcinoma or mucinous morphology, and one for patients having metastases at diagnosis. Women showed significant differences in right colon cases from the youngest to oldest age group (36% vs. 45% vs. 60%). Men <50 years had a significantly higher mucinous carcinoma percentage than their female counterparts (22% vs. 11%), while in the oldest age group women had the highest percentage (15% vs. 11%). The metastatic pattern differed between men and women and by age. The three-year relative survival in the <50 age group was better for women than men, but this survival advantage was reversed in the oldest group. In conclusion, sex and age are factors that influence the biological and clinical characteristics of colorectal cancer, affecting the metastatic pattern as well as patient survival.

Primary Colorectal Tumor Displays Differential Genomic Expression Profiles Associated with Hepatic and Peritoneal Metastases

“…Moreover, the biological processes implicated in different metastatic routes are highly independent. Recent data support the potential role of additional physiological factors, such as age and sex, in the metastatic dissemination of CRC [63,64]. In hypermethylated CRC, we identified a metastatic cascade toward the peritoneum through the production of a tumor sphere with inverted polarity [65,66].…”

Gender oncology: recommendations and consensus of the Italian Association of Medical Oncology (AIOM)

“…Different therapeutic approaches in women and men with colorectal cancer should be investigated. 54 , 68 , 69 8 With new techniques of analysis belonging to the discipline of metabolomics, differences have been demonstrated in the molecular processes of male and female tumours and, therefore, in cancer growth strategies: women with colon cancer have higher levels of fatty acids, responsible for energy production by oxidation, while in male patients there is an increase in the levels of other metabolites such as lactate that produce energy through a different pathway, less erosive than oxidation. Different therapeutic approaches to stop colorectal cancer growth in women and men should be investigated.…”

Sex Differences in Colon Cancer: Genomic and Nongenomic Signalling of Oestrogen

“…These premenopausal advantages and the observations that hormone replacement therapy (HRT) may also be protective in CRC [19][20][21] indicate a role for the female sex steroid hormone oestrogen in delaying the onset and reducing mortality in females with colon cancer [22,23]. Sexual disparity has also been shown in epidemiological studies to be an important factor in the site of onset and metastases in CRC [24]. Women show a higher frequency of right-sided tumours (proximal colon) than men who present more commonly with left-sided (distal colon) tumours [25].…”