Elsevier

European Journal of Cancer

Volume 34, Issue 14, December 1998, Pages 2271-2278
European Journal of Cancer

Original Paper
The prognostic role of gender in survival of adult cancer patients

https://doi.org/10.1016/S0959-8049(98)00324-4Get rights and content

Abstract

Many observations indicate that women have a much longer expectancy of life than men. Some population-based studies on cancer patients support the idea of the role of gender in predicting survival. However, the data are somewhat contrasting and inconclusive. The purpose of this paper was to evaluate the prognostic role of gender for cancer patients, making use of the large set of survival data made available by the EUROCARE II project for the period 1985–1989. By applying a multivariate approach the major confounders such as age, geographical area and cancer site were considered in analysing survival data on more than 1 million cancer cases collected by 45 population-based cancer registries in 17 European countries. The results were consistent with the general observation that in the industrialised countries women tend to survive longer than men. The multivariate analysis showed better survival from cancer in women than in men, estimated as an overall 2% lower relative risk of dying. The female advantage was particularly evident in young cases, reduced in patients in middle age groups and in the oldest patients completely reversed so that at this age men had the better prognosis. Longer survival for women was not present immediately after diagnosis, but the major advantage was seen after 3 years of follow-up. The risk of death for women was significantly lower for cancer of the head and neck, oesophagus, stomach, liver and pancreas. For bladder cancer, the risk of death was significantly greater for women. These results can be explained by gender differences in sub-site distributions (head and neck and stomach) and by the differences in the stage at diagnosis (presumably bladder). However, the consistency of the data, evident only when a vast set of data is analysed, suggest that women may be intrinsically more robust than men in coping with cancer.

Introduction

Life expectancy for women at birth exceeds that for men in almost all countries, exceptions being Bangladesh, Bhutan, India, Nepal and Pakistan; the anomaly of these countries generally being considered as an effect of strong discrimination against women[1]. In most industrialised countries, the greater life expectancy of women has been known for a long time[2]. In Sweden, the country with the longest reliable mortality statistics, female life expectation at birth has exceeded males since 1751 when data became available[1]. Some researchers predict that the gender gap will increase in the near future[3], whilst others suggest it will decrease slightly[4]. One view of the phenomenon is that it is biological and approaches the status of a law of nature. However, even if women do have an advantage over men in terms of psychological and biological robustness[2], the causes of this difference remain poorly understood.

The potential effect of gender as a predictor of life expectancy of cancer patients has not been sufficiently investigated. EUROCARE I, a project for estimating the survival of European cancer patients diagnosed during 1978–1985[5]and other studies found that female gender is a favourable prognostic factor for survival, even after adjusting for competing mortality (i.e. when relative survival were considered) and age6, 7, 8, 9.

The aim of the present study was to evaluate gender differences in cancer survival in a large set of data collected across 45 population-based cancer registries in 17 European countries (EUROCARE II). By analysing such a large set of survival data, undesirable random effects will be reduced, facilitating identification of the potential prognostic role of gender after adjusting for competing mortality, age, geographical area and cancer site.

Section snippets

Patients and methods

Survival analysis was carried out on 1 188 469 malignant cancer adult patients (ICD9: 140–208 except 173) diagnosed from 1985 to 1989 in 17 European populations participating in EUROCARE II. Cases discovered at autopsy, first diagnosed with another malignant tumour or known on the basis of death certificates only (DCO) were not included. Cases were followed for a minimum of 5 years after diagnosis. Some registries (Denmark, Estonia, Finland, Slovakia, Slovenia and Iceland) cover the population of

Life expectancy

In all countries participating in the EUROCARE II study, life expectancy at birth was higher for women than for men according to WHO 1992 data (Fig. 1)[11]. Differences between the sexes ranged from around 4 years in Iceland, where the expectation of life for men was 76.8 years, to 11.2 years in Estonia, where the expectation of life for men was 63.6 years (Table 1). The three highest differences were observed in the Eastern European countries Estonia, Poland and Slovakia; whereas the three

Discussion

Women generally have a much longer life expectancy than men. Several earlier observations suggested that this female advantage is present in cancer patients, even after adjusting for competing mortality5, 6, 9. The purpose of the present study was to evaluate the role of gender as a potential predictor of survival in cancer patients, making use of the very large population-based data-set of the EUROCARE II. To our knowledge, this is the first time that gender has been analysed as predictor of

Acknowledgements

The EUROCARE study was financed through the BIOMED programme of the European Union.

References (25)

  • Coebergh JWW. Summary and discussion of results. In Berrino F, Sant M, Verdecchia A, Capocaccia R, Hakulinen T, Esteve...
  • Micheli A, Gatta G, Verdecchia A. Studying survival of cancer patients in different populations: its potential and...
  • Cited by (0)

    1

    The EUROCARE Working Group for this study is listed in the Appendix A.

    View full text