J Cancer 2021; 12(2):498-507. doi:10.7150/jca.50536

Research Paper

Sex Disparities in the Clinical Characteristics, Synchronous Distant Metastasis Occurrence and Prognosis: A Pan-cancer Analysis

Yutong Wang1, Ziqian Zeng1,2, Mingshuang Tang1, Min Zhang3, Ye Bai3, Huijie Cui1, Yao Xu4, Xu Guo4,5, Wenjuan Ma6, Guijun Xu4,7, Lisha Qi8, Jingyi Wang8, Siyu Chen1, Dongqing Gu1, Min Mao9✉, Xin Wang1✉, Chao Zhang4✉

1. Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China.
2. Department of Epidemiology, Chengdu Medical College, Chengdu, 610599, Sichuan province, China.
3. Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400038, China.
4. Department of Bone and Soft Tissue Tumours, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.
5. Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, Hebei, 061000, China.
6. Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.
7. Department of Orthopedics, Tianjin Hospital, Tianjin 300060, China.
8. Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
9. Department of Pathology and Southwest Cancer Center, First Affiliated Hospital, Army Medical University, Chongqing 400038, China.

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Citation:
Wang Y, Zeng Z, Tang M, Zhang M, Bai Y, Cui H, Xu Y, Guo X, Ma W, Xu G, Qi L, Wang J, Chen S, Gu D, Mao M, Wang X, Zhang C. Sex Disparities in the Clinical Characteristics, Synchronous Distant Metastasis Occurrence and Prognosis: A Pan-cancer Analysis. J Cancer 2021; 12(2):498-507. doi:10.7150/jca.50536. Available from https://www.jcancer.org/v12p0498.htm

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Abstract

Background: This study aims to assess the sex disparities in clinical characteristics and synchronous distant metastasis occurrence at diagnosis, as well as the subsequent prognosis in non-sex-specific cancers.

Methods: The study included details from patients diagnosed with non-sex-specific cancers, during the period from 2010 to 2016, in the Surveillance, Epidemiology, and End Results (SEER) program. The distant metastasis prevalence and subsequent survival time were summarized in the total population and the population with specific cancers of different systems. The multivariable logistic and the Cox proportional hazards regressions were applied to evaluate the sex effect on distant metastasis occurrence and prognosis. The results were combined using meta-analysis.

Results: Across all non-sex-specific cancers, the pooled prevalence of distant metastasis was 15.2% (95% CI: 14.7-15.7%) and 7.1% (95% CI: 6.8-7.3%) for males and females, respectively. The pooled median survival time was 8.40 months (95% CI: 7.99-8.81) for male patients and 9.40 months (95% CI: 8.84-10.02) for female patients. After combining all non-sex-specific cancers, male patients displayed a higher distant metastasis occurrence than females (pooled OR=1.06, 95% CI: 1.04-1.08; P<0.01), as well as worse overall survival after distant metastasis (pooled HR=1.08, 95% CI: 1.05-1.10; P<0.01). The sex differences were more significant in patients younger than 65 years (P<0.01). Additionally, the sex influence on prognosis was most predominant amongst patients from Asian or Pacific Islander ethnic groups.

Conclusion: Male gender appears to be an independent risk factor associated with the occurrence and prognosis of synchronous distant metastasis. Therefore, sex-specific preventions and treatments should become the focus of future research.

Keywords: SEER, sex disparities, distant metastasis, prevalence, prognosis