Genderaspekte bei Tumoren des Gastrointestinaltrakts und ihre Prognose, insbesondere im Rahmen multimodaler Therapiekonzepte

 

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Zusammenfassung

Für den Gastrointestinaltrakt wurden bisher keine systematischen Untersuchungen zum Einfluss des Geschlechts auf den Verlauf von malignen Erkrankungen publiziert, u. a., weil „Geschlecht“ in den bedeutenden Studien zum Thema meist kein Stratifikationskriterium war. Es ist jedoch unumstritten, dass sich die gastrointestinalen Tumoren in Risikofaktoren, Inzidenz und Prognose geschlechtsspezifisch unterscheiden. Diese Übersichtsarbeit fasst die wichtigsten Kenntnisse zu den biologischen („sex“) und soziokulturellen („gender“) Geschlechterunterschieden zusammen und betrachtet anatomische Unterschiede mit direkter Konsequenz für die chirurgische Intervention. Im oberen Gastrointestinaltrakt existieren die bedeutendsten epidemiologischen Unterschiede hinsichtlich der histologischen Subtypen mit direkten Konsequenzen für Diagnostik, Therapie und Prognose. Bei vielen Tumorentitäten haben Frauen eine bessere Prognose. Beim kolorektalen Karzinom scheinen Sexualhormone, insbesondere Östrogene, eine bedeutende Rolle in der Tumorentstehung zu spielen. Die histopathologische Bestimmung der Expression des Östrogenrezeptors beta (ERβ) im Tumorgewebe von Patienten mit Kolonkarzinom hat Bedeutung erlangt, seitdem Studien gezeigt haben, dass die Prognose bei Frauen mit niedriger ERβ-Expression günstiger zu beurteilen ist als bei Männern mit vergleichbarem Rezeptorstatus. Die Kenntnis über eine häufigere rechtsseitige Lokalisation von Kolonkarzinomen und nicht polypoiden Neoplasien bei Frauen könnte zu verbesserten Präventionsmaßnahmen führen. Männer und Frauen nehmen die empfohlenen Vorsorgekoloskopien aus unterschiedlichen Gründen nicht wahr, hier könnte mit geschlechterspezifischen Ansätzen die Darmkrebsvorsorge verbessert werden. Um Nebenwirkungen bei der adjuvanten Chemotherapie zu vermeiden, sind Daten zur unterschiedlichen Bioverfügbarkeit z. B. von 5-FU (5-Fluoruracil) bei Frauen und Männern nützlich und sollten bei der Dosierung beachtet werden. Die weiterführende systematische Aufarbeitung des Geschlechteraspekts bei gastrointestinalen Tumoren wäre wünschenswert und ein bedeutender Schritt in Richtung personalisierte onkologische Chirurgie.

Abstract

Systematic analyses of gender effects in gastrointestinal malignancies are currently lacking, partly because sex and gender have not been used as stratification criteria in major studies on the topic. It is, however, indisputable that gastrointestinal tumours differ in risk factors, incidence and prognosis between the genders. This review summarises the most important findings on differences related to biological sex and sociocultural gender and discusses anatomic specifics with immediate significance for surgical interventions. Epidemiological differences in upper gastrointestinal malignancies are most prominent in regard to histological subtypes, directly affecting diagnostics, therapy, and prognosis. Women have a better prognosis in many of these tumour subtypes. For colorectal carcinoma, sex hormones, specifically oestrogens, appear to play a distinct role in tumourigenesis. Histopathological analysis of the expression of oestrogen receptor beta (ERβ) in the tumour tissue has attracted interest since it was shown that women with low ERβ expression have a better prognosis than men with comparable ERβ status. Data on the higher incidence of right-sided colon carcinoma and non-polypoid neoplasms in women could lead to improved screening programmes. Men and women cite differing reasons for avoidance of screening colonoscopies, thus gender specific approaches could improve colon cancer prevention programmes. Data on differing bioavailability of 5-fluorouracil between the genders are useful to minimise adverse effects of chemotherapy and should be accounted for in dosage. Further systematic analysis of gender effects on gastrointestinal tumours is warranted and would be a substantial step towards personalised oncological surgery.

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