The prognostic role of gender in survival of adult cancer patients

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. (C) 1998 Elsevier Science Ltd. All rights reserved.