Geschlechtsspezifische Einflüsse auf Inzidenz, Risikofaktoren und Prognose von Karzinomen der Leber, Gallenblase, extrahepatischen Gallenwege und des Pankreas

Zusammenfassung

Hintergrund: In dieser Übersicht wird zu potenziellen geschlechtsspezifischen Unterschieden hinsichtlich Inzidenz, Risikofaktoren und Prognose bei Patienten mit Karzinomen der Leber, Gallenblase, extrahepatischen Gallenwege und Pankreas Stellung genommen.
Methodik: Es wurde die Datenbank MEDLINE (PubMed) unter den Schlüsselwörtern „liver cancer“, „gallbladder cancer“, „extrahepatic bile duct carcinoma“, „pancreatic cancer“ AND „gender“ durchsucht.
Ergebnisse: Es ergaben sich deutliche geschlechtsspezifische Unterschiede in der Epidemiologie der analysierten Karzinome. So tritt das HCC sehr viel häufiger bei Männern als bei Frauen auf, 1 von 86 Männern, aber nur 1 von 200 Frauen entwickeln in Deutschland im Laufe ihres Lebens einen bösartigen primären Lebertumor. Das Lebenszeitrisiko für Karzinome der Gallenblase und extrahepatische Karzinome beträgt in Deutschland etwa 0,6 % für Frauen und 0,5 % für Männer, speziell Gallenblasenkarzinome werden bei Frauen häufiger als bei Männern beobachtet. Für das Pankreaskarzinom kann in Deutschland keine eindeutige geschlechtsspezifische Präferenz angegeben werden, wenn auch das Sterblichkeitsrisiko der Männer höher als das der Frauen ist (altersstandardisierte Sterberate pro 100 000 Personen bei Männern 12,8 vs. 9,5 bei den Frauen). Auffallend ist darüber hinaus die Verschiebung der Tumorinzidenz in den letzten Jahrzehnten. Leberkarzinome haben bei Männern in Deutschland um ca. 50 % in den letzten 30 Jahren zugenommen, die Inzidenz des Gallenblasenkarzinoms umgekehrt ist rückläufig. Die Prognose dieser Karzinome ist, über alle Tumorstadien gesehen, im unselektionierten Krankengut durchgehend schlecht. Dies dürfte der wesentliche Grund dafür sein, dass in der Tendenz nur geringe – wenn überhaupt – geschlechtsspezifische Unterschiede im Überleben beschrieben sind.
Schlussfolgerung: Neben der Vermeidung der bekannten Risikofaktoren wie Hepatitis-B- und -C-Virusinfektionen, Alkoholabusus und Rauchen kommt mittlerweile der Vermeidung von Übergewicht und Adipositas eine wichtige Rolle bei der Prophylaxe dieser Karzinome zu.

Abstract

Background: This overview comments on gender-specific differences in incidence, risk factors and prognosis in patients with carcinoma of the liver, gallbladder, extrahepatic bile duct and pancreas.
Method: For the literature review, the MEDLINE database (PubMed) was searched under the key words “liver cancer”, “gallbladder cancer”, “extrahepatic bile duct carcinoma”, “pancreatic cancer” AND “gender”.
Results: There were significant gender differences in the epidemiology of the analysed carcinomas. The incidence of hepatocellular carcinoma (HCC) is much higher in men than in women, one of 86 men, but only 1 out of 200 women develop a malignant primary liver tumour in Germany in the course of their life. The lifetime risk for carcinomas of the gallbladder and extrahepatic bile ducts in Germany amounts to about 0.6 % for women and 0.5 % for men, specifically gallbladder carcinomas are observed more frequently in women than in men. For pancreatic cancer, no clear gender preference exists in Germany, although the mortality risk for men is higher than that for women (age-adjusted standardised death rate in men 12.8/100 000 persons, in women 9.5). Remarkable is furthermore the shift of the tumour incidence in the last decades. Liver cancer has increased among men in Germany by about 50 % in the last 30 years, the incidence of gallbladder carcinoma has inversely dropped. The prognosis of these cancers across all tumour stages is uniformly bad in an unselected patient population. This is probably the main reason why only little – if any – gender differences in survival are described.
Conclusion: In addition to avoiding the known risk factors such as hepatitis B and C virus infection, alcohol abuse, and smoking, the avoidance of overweight and obesity plays an increasingly important role in the prevention of these cancers.

Schlüsselwörter

Geschlecht - Leberkarzinom - Gallenblasenkarzinom - Pankreaskarzinom - extrahepatisches Gallengangkarzinom

Key words

gender - liver cancer - gallbladder cancer - pancreatic cancer - extrahepatic cholangiocarcinoma

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