- 作者：Edward N. Rampersaud ; Tobias Klatte ; Geoffrey Bass ; Jean-Jacques Patard ; Karim Bensaleh ; Malte B枚hm ; Ernst P. Allhoff ; Luca Cindolo ; Alex ; re De La Taille ; Arnaud Mejean ; Michel Soulie ; Laurent Bellec ; Jean Christophe Bernhard ; Christian Pfister ; Marc Colombel ; Arie S. Belldegrun ; Allan J. Pantuck ; Daniel George
- 关键词：Gender ; Age groups ; Sex hormones ; Epidemiology ; Renal cell carcinoma
- 刊名：Urologic Oncology: Seminars and Original Investigations
- 出版年：January, 2014
- 年：2014
- 卷：32
- 期：1
- 页码：30.e9-30.e13
- 全文大小：407 K
ss="h4">Objective
Gender-specific differences in incidence of renal cell carcinoma (RCC) and its outcome have previously been reported. We used age as a surrogate to test whether this might be hormone-related in a large international RCC cohort.ss="h4">Methods and Materials
This study included patients treated by nephrectomy at 10 international academic centers. Clinicopathologic features were assessed using chi-square and the Student t-tests. Kaplan-Meier survival estimates and Cox proportional hazards models addressed the effect of gender and age on disease-specific survival.
ss="h4">Results
Of the 5,654 patients, 3,777 (67%) were men and 1,877 (33%) were women. Generally, women presented at lower T stages (P<0.001), had fewer metastases (P<0.001), and had lower-grade tumors (P<0.001). Women more frequently had clear-cell (87% vs. 82%) and less frequently had papillary RCC (7% vs. 12%) than men (P<0.001). Women had a 19% reduced risk of death from RCC than men (hazard ratio 0.81, 95% confidence interval 0.73-0.90, P<0.001). The survival advantage for women was present to the greatest degree in the age group<42 years (P = 0.0136) and in women aged 42 to 58 years (P<0.001), but was not apparent in patients aged 59 years and older (P = 0.248). Age was an independent predictor of disease-specific survival in women (hazard ratio 1.011, 95% confidence interval 1.004-1.019, P = 0.004), but not in men.
ss="h4">Conclusions
As a group, women present with less advanced tumors, leading to a 19% reduced risk of RCC-specific death compared with men. This survival difference is present only in patients aged<59 years. Because this gender-based survival difference is not related to pathologic features, the role of hormonal effects on the development and progression of RCC needs to be investigated.