Manuela Limam1,2, Katarina Luise Matthes1,2, Giulia Pestoni1,2, Eleftheria Michalopoulou1, Leonhard Held1, Silvia Dehler1,2, Dimitri Korol2, Sabine Rohrmann3,4. 1. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland. 2. Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, University Hospital Zurich, Zurich, Switzerland. 3. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland. Sabine.Rohrmann@usz.ch. 4. Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, University Hospital Zurich, Zurich, Switzerland. Sabine.Rohrmann@usz.ch.
Abstract
BACKGROUND: Colorectal cancer (CRC) is among the three most common incident cancers and causes of cancer death in Switzerland for both men and women. To promote aspects of gender medicine, we examined differences in treatment decision and survival by sex in CRC patients diagnosed 2000 and 2001 in the canton of Zurich, Switzerland. METHODS: Characteristics assessed of 1076 CRC patients were sex, tumor subsite, age at diagnosis, tumor stage, primary treatment option and comorbidity rated by the Charlson Comorbidity Index (CCI). Missing data for stage and comorbidities were completed using multivariate imputation by chained equations. We estimated the probability of receiving surgery versus another primary treatment using multivariable binomial logistic regression models. Univariable and multivariable Cox proportional hazards regression models were used for survival analysis. RESULTS: Females were older at diagnosis and had less comorbidities than men. There was no difference with respect to treatment decisions between men and women. The probability of receiving a primary treatment other than surgery was nearly twice as high in patients with the highest comorbidity index, CCI 2+, compared with patients without comorbidities. This effect was significantly stronger in women than in men (p-interaction = 0.010). Survival decreased with higher CCI, tumor stage and age in all CRC patients. Sex had no impact on survival. CONCLUSION: The probability of receiving any primary treatment and survival were independent of sex. However, female CRC patients with the highest CCI appeared more likely to receive other therapy than surgery compared to their male counterparts.
BACKGROUND:Colorectal cancer (CRC) is among the three most common incident cancers and causes of cancer death in Switzerland for both men and women. To promote aspects of gender medicine, we examined differences in treatment decision and survival by sex in CRCpatients diagnosed 2000 and 2001 in the canton of Zurich, Switzerland. METHODS: Characteristics assessed of 1076 CRCpatients were sex, tumor subsite, age at diagnosis, tumor stage, primary treatment option and comorbidity rated by the Charlson Comorbidity Index (CCI). Missing data for stage and comorbidities were completed using multivariate imputation by chained equations. We estimated the probability of receiving surgery versus another primary treatment using multivariable binomial logistic regression models. Univariable and multivariable Cox proportional hazards regression models were used for survival analysis. RESULTS: Females were older at diagnosis and had less comorbidities than men. There was no difference with respect to treatment decisions between men and women. The probability of receiving a primary treatment other than surgery was nearly twice as high in patients with the highest comorbidity index, CCI 2+, compared with patients without comorbidities. This effect was significantly stronger in women than in men (p-interaction = 0.010). Survival decreased with higher CCI, tumor stage and age in all CRCpatients. Sex had no impact on survival. CONCLUSION: The probability of receiving any primary treatment and survival were independent of sex. However, female CRCpatients with the highest CCI appeared more likely to receive other therapy than surgery compared to their male counterparts.
Entities:
Keywords:
Colorectal cancer; Comorbidity; Sex differences; Survival; Treatment
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