Gender and survival in malignant tumours

Background: Epidemiological evidence supports the existence of a survival a dvantage for female patients with melanoma. This survival advantage often p ersists when other prognostic variables are taken into account. The basis f or this female advantage or male disadvantage is not established although f emale sex steroids can retard melanoma invasion in vitro. Design: In considering the mechanisms involved, we have examined the litera ture to establish whether this female survival advantage is shared by other solid tumours. The tumours selected were breast, lung, colorectal, oesopha geal, gastric, pancreatic and soft tissue sarcoma. A Medline database searc h was carried out to identify those studies in which gender was investigate d as a prognostic indicator. Results: Results from large, mostly retrospective series show that for 5 of these 7 tumour groups, there is evidence for a female survival advantage. In particular, this survival advantage is usually more prominent in early s tage disease. Conclusion: Melanoma is not unique in showing a female survival advantage, Although the current literature does not address the mechanisms involved, w e suggest that these are worth investigating as they may contribute to new treatment modalities aimed at preventing metastatic spread. 2001 Harcourt P ublishers Ltd.