Influence Of Gender On Clinical, Pathological And Prognostic Characteristics Of Rectal Cancer In Morocco: A Single Institution Experience

Introduction: Rectal cancer is a major health problem worldwide. Sex differences in incidence and mortality rates have been reported and attributed to biological and environmental factors, including diet and hormones. The aim of our study was to assess differences in clinicopathological parameters and therapeutic outcomes of rectal cancer (RC) between men and women.Methods: From April 2007 to December 2012, 105 cases of RC were registered at the department of medical oncology of Hassan II University Hospital of Fez, Morocco, and reviewed retrospectively. Data regarding demographics, smoking, histology, treatment and survival were obtained.Results: There were 42 women and 63 men with RC. The mean age was 50.5 years in women versus 56.6 years in men. Women were more frequently non-smokers than men: 4.7% (n = 2) versus 41.2% (n = 26) p = 0,0001. Signet ring adenocarcinoma was predominant in men (14.3% versus 6%; p = 0,001). A trend to have more aggressive stage III/IV disease at presentation was observed among men: 80.9% vs 54.7% respectively (p = 0.02). 16.6% of women had a poor performance status (2/4 on the ECOG scale) versus 33.3% of men: p = 0.003. More women underwent complete resection with sphincter preservation after preoperative treatment of localized lower rectal cancers (26.1% in women versus 14.2%; p = 0.005). A higher percentage of men received palliative monotherapy and best supportive care (25% in men versus 17% in women; p = 0.05). After a mean follow up of 27 months, progression free survival and disease free survival were shorter in men than in women (4 versus 7 months: p = 0.02, and 12 versus 14 months: p = 0.05 respectively).Conclusion: Our study suggests that rectal cancer is more aggressive in men. Recognition of important sex disparities in these areas may lead to the implementation of specific measures to diminish these differences and identify specific molecular targets on rectal cancer that interact with estrogen in order to stimulate research to improve the overall outcomes of all patients with rectal cancer. Introduction: Rectal cancer is a major health problem worldwide. Sex differences in incidence and mortality rates have been reported and attributed to biological and environmental factors, including diet and hormones. The aim of our study was to assess differences in clinicopathological parameters and therapeutic outcomes of rectal cancer (RC) between men and women. Methods: From April 2007 to December 2012, 105 cases of RC were registered at the department of medical oncology of Hassan II University Hospital of Fez, Morocco, and reviewed retrospectively. Data regarding demographics, smoking, histology, treatment and survival were obtained. Results: There were 42 women and 63 men with RC. The mean age was 50.5 years in women versus 56.6 years in men. Women were more frequently non-smokers than men: 4.7% (n = 2) versus 41.2% (n = 26) p = 0,0001. Signet ring adenocarcinoma was predominant in men (14.3% versus 6%; p = 0,001). A trend to have more aggressive stage III/IV disease at presentation was observed among men: 80.9% vs 54.7% respectively (p = 0.02). 16.6% of women had a poor performance status (2/4 on the ECOG scale) versus 33.3% of men: p = 0.003. More women underwent complete resection with sphincter preservation after preoperative treatment of localized lower rectal cancers (26.1% in women versus 14.2%; p = 0.005). A higher percentage of men received palliative monotherapy and best supportive care (25% in men versus 17% in women; p = 0.05). After a mean follow up of 27 months, progression free survival and disease free survival were shorter in men than in women (4 versus 7 months: p = 0.02, and 12 versus 14 months: p = 0.05 respectively). Conclusion: Our study suggests that rectal cancer is more aggressive in men. Recognition of important sex disparities in these areas may lead to the implementation of specific measures to diminish these differences and identify specific molecular targets on rectal cancer that interact with estrogen in order to stimulate research to improve the overall outcomes of all patients with rectal cancer.