Geschlechtsspezifische Einflüsse auf Inzidenz, Screening, Behandlung und Ergebnis des kolorektalen Karzinoms^[*]

Zusammenfassung

Hintergrund: In dieser Übersicht soll zu potenziellen geschlechtsspezifischen Unterschieden hinsichtlich Inzidenz, Lokalisation, Screening, Therapie und Ergebnis bei Patienten mit kolorektalem Karzinom (KRK) Stellung genommen werden. Methodik: Für die Literaturübersicht wurde die Datenbank Medline (PubMed) unter den Schlüsselwörtern „colorectal carcinoma AND gender“ sowie „gender differences AND colorectal cancer“ durchsucht. Es wurden primär Veröffentlichungen der letzten 9 Jahre (2005–2013) abgefragt. Ergebnisse: KRK werden häufiger bei Männern als bei Frauen beobachtet, wobei das höhere Tumorrisiko der Männer sich auf das distale Kolonkarzinom und das Rektumkarzinom beschränkt. Zu den Risikofaktoren für die Entwicklung eines KRK gehören Übergewicht und Adipositas, diese Beziehung ist für Männer ausgeprägter als für Frauen. Inwieweit das Geschlecht einen prognostischen Faktor für das Patientenüberleben darstellt, ist umstritten. Ein besseres Überleben der Frauen im Vergleich zu Männern wird vor allem in den jüngeren Altersklassen gefunden, woraus sich ein protektiver Effekt der Östrogene auf die Entwicklung eines KRK ableiten lässt. Was die Häufigkeit angeht, mit der sich Männer und Frauen einem Screening des KRK unterziehen, so werden zwar manchmal für Männer im Vergleich zu Frauen höhere Screening-Raten berichtet, jedoch hat der sozioökonomische Status der Eingeladenen sehr viel mehr Einfluss auf die Screening-Beteiligung als das Geschlecht. Die Analyse der Operationsverfahren deutet an, dass die tiefe Resektion bei Männern schwieriger als bei Frauen durchzuführen ist, was in Zentren mit geringer Erfahrung in der Rektumchirurgie die Rate an abdominoperinealen Rektumexzisionen bei Männern ansteigen lässt. Auch ist das Risiko einer Anastomoseninsuffizienz bei Männern höher als bei Frauen. Schlussfolgerung: Der wesentliche geschlechtsspezifische Unterschied ist aber die längere Lebenserwartung der Frauen im Vergleich zu Männern, der in den Studien nicht immer klar (risikoadjustiert) herausgearbeitet wurde. Dies kann zu einem nicht geringen Maß bereits allein die ungünstigere Prognose von rechts- verglichen mit linksseitigen Kolonkarzinomen erklären. Das KRK-Risiko der Frauen erreicht erst in einem höheren Lebensalter das Niveau der Männer. Ob dieser Umstand die Effektivität von Vorsorgeuntersuchungen beeinflusst, wurde nicht hinlänglich überprüft. Die Daten sprechen aber dafür, Screening-Empfehlungen dieser Tatsache anzupassen.

Abstract

Background: This overview comments on potential gender-specific differences in incidence, anatomic site, screening, treatment, and outcome in patients with colorectal cancer (CRC). Method: For the literature review, the Medline database (PubMed) was searched under the key words „colorectal carcinoma AND gender“ and „gender differences AND colorectal cancer“. Publications of the last 9 years (2005–2013) were firstly retrieved. Results: CRC is more commonly observed in men than in women, with the higher tumour risk for men being limited to the distal colon and rectum. Risk factors for the development of CRC include overweight and obesity, this relationship is more pronounced for men than for women. The extent to which gender is a prognostic factor for patient survival is controversial. A better survival of women compared to men is found especially in the younger age groups, from which can be derived a protective effect of oestrogens on the development of CRC. As for the frequency with which men and women undergo a screening of CRC, sometimes higher screening rates have been reported for men than women, however, the socio-economic status of persons invited to participate has much more influence on screening attendance than gender. An analysis of surgical procedures indicates that it is more difficult to perform the low anterior resection of the rectum in men than women, with the result that men managed by less experienced surgeons are more likely to receive abdominoperineal excision. Furthermore, the risk of anastomotic leakage is higher in men than women. Conclusion: The essential gender difference, however, is the longer life expectancy of women compared to men which has been not always clearly (risk adjusted) elaborated in the studies available so far. This difference alone can already explain at a high rate the poorer prognosis of right-sided colon cancers compared to left-sided cancers. Comparable levels of CRC risk are reached in women as compared to men at a higher age. This may influence the effectiveness of screening programmes and has not been sufficiently examined. Evidence suggests the adaptation of screening recommendations to this fact.

Schlüsselwörter

Geschlecht - Inzidenz - Screening - Überleben - kolorektales Karzinom

Key words

gender - incidence - screening - survival - colorectal cancer

^* Prof. Dr. Dr. H. Lippert gewidmet

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