Zusammenfassung
Für den Gastrointestinaltrakt wurden bisher keine systematischen Untersuchungen zum Einfluss des Geschlechts auf den Verlauf von malignen Erkrankungen durchgeführt und das „Geschlecht“ war bisher meist kein Stratifikationskriterium in Studien. Es ist jedoch unumstritten, dass sich die gastrointestinalen Tumoren bezüglich Risikofaktoren, Inzidenz und Prognose geschlechtsspezifisch unterscheiden. Diese Übersichtsarbeit fasst die wichtigsten Kenntnisse zu epidemiologischen Faktoren, pathologischen Grundlagen, Prognose, Rezidivmustern und unterschiedlichem Ansprechen auf multimodale Therapiekonzepte aus der Sicht der Gendermedizin zusammen. Frauen haben häufiger nichtintestinale Tumoren mit niedriger Differenzierung und Siegelringzellen. Zum Ansprechen auf eine Chemotherapie liegen keine konklusiven Daten vor, allerdings zeigt sich ein Trend Richtung schlechteres Ansprechen des weiblichen Geschlechts sowie eines häufigeren Auftretens einer Peritonealkarzinose als Rezidivlokalisation. Trotzdem haben Frauen mit Magen- und Ösophaguskarzinom analog zu weiteren Tumorentitäten in epidemiologischen Daten eine bessere Prognose. Insgesamt bleiben viele Fragen offen. Die systematische Aufarbeitung des Geschlechteraspekts bei gastrointestinalen Tumoren bietet aber viele interessante Ansatzpunkte und sollte in zukünftige Studien eingebunden werden.
Abstract
Systematic analyses of gender effects in upper gastrointestinal (GI) malignancies are currently lacking and sex and/or gender have not been used as stratification criteria in most studies. It is generally accepted that a gender difference exists in upper GI tumors with respect to risk factors, incidence, histopathology, and prognosis. This review summarizes the most important findings on gender differences in upper GI tumors. Women have a lower incidence of upper GI tumors compared to men; “female” tumors are more often less differentiated, of nonintestinal Laurén subtype and contain signet cells. The data on tumor response to multimodal therapy are inconclusive. However there is a trend towards lower response rates in women. The pattern of recurrence often includes peritoneal carcinomatosis in women. However, epidemiological data show better survival for women with esophageal or gastric cancer compared to men similarly to many other tumor entities. So far, many questions remain unanswered. Thus, further systematic analyses of gender effects and their inclusion in clinical studies are highly warranted.
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Danksagung
Die Autoren danken Prof. Siewert und Prof. Büchler für die Option der geschlechtsspezifischen Analysen an ihren Patientenkollektiven. Die Daten wurden am Chirurgenkongress 2012 und 2015 präsentiert.
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K. Ott, O. Pech, T. Schmidt und S. Blank geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
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M. Müller-Schilling, Regensburg
A. Riphaus, Frankfurt am Main
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Ott, K., Pech, O., Schmidt, T. et al. Gender und Tumoren des oberen Gastrointestinaltrakts. Gastroenterologe 14, 108–115 (2019). https://doi.org/10.1007/s11377-019-0330-9
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DOI: https://doi.org/10.1007/s11377-019-0330-9