|
|
Back to 2016 Annual Meeting
Gender Specific Differences in Colon Cancer When Quality Measures Are Adhered To: Results From International, Prospective, Multicenter Clinical Trials
Shrawan G. Gaitonde*1, Aviram Nissan3, Mladjan Protić2, Alexander Stojadinovic4, Zev Wainberg5, David Chen5, Anton J. Bilchik1
1Surgical Oncology, John Wayne Cancer Institute, Santa Monica, CA; 2Clinical Centre of Vajvodina, University of Nov Sad, Novi Sad, Serbia; 3Chaim Sheba Medical Center, Tel Hashomer, Israel; 4Uniformed Services University of the Health Sciences, Bethesda, MD; 5UCLA, Los Angeles, CA
Introduction: Although much attention has been given to gender-related differences in colorectal cancer (CRC), as yet there is no consensus on the relationship between gender and tumor location, stage and oncologic outcome. Additionally, newer data suggest that screening is less consistent in the female population. We hypothesized that gender-specific management of CRC might be associated with outcome.
Methods: Our cohort was drawn from a CRC database for prospective international trials of targeted nodal assessment in non-metastatic CRC, of 888 patients. Patients were enrolled with strict adherence to surgical and pathological quality measures. Patients were followed clinically, with colonoscopy at 1 and 4 years after surgery and annual CT scans. Gender-specific differences in tumor biology, location, stage and recurrence were evaluated by Chi-squared, Fischer’s exact test, and independent t-tests.
Results: The cohort included 428 males and 416 females. Females had more right-sided (p=0.03) and earlier T stage (p=0.05) tumors, but there was no gender-based difference in pathologic grade, total LN’s retrieved, LN positivity (p=0.47) or lymphovascular invasion (p=0.45). The overall 4 year disease-free survival (DFS) was 86.7% vs 84.8% in females vs males respectively (p=0.236) and by multivariate analysis only nodal positivity and recurrence impacted overall survival (OS) (p=0.008). No difference existed between gender and location in OS (p=0.744) or DFS (p=0.327).
Conclusion: This is the first prospective study to demonstrate gender-specific differences in location and T stage of lesions in CRC with attention to surgical and pathological quality standards. The predominance of right sided CRC in females suggests that flexible sigmoidoscopy may be inadequate for screening/surveillance and gender-based differences in tumor biology may exist. Despite earlier stage and right-sided tumors, these historically favorable lesions did not confer a DFS or OS advantage for women. Further studies are needed to determine why females have a higher propensity for right-sided lesions, and why their overall survival is not improved.
Back to 2016 Annual Meeting
|
