Gender differences in stage at diagnosis and preoperative radiotherapy in patients with rectal cancer
Authors: Sarasqueta Cristina , Zunzunegui Mª Victoria , Enríquez Navascues José María , Querejeta Arrate , Placer Carlos , Perales Amaia , Gonzalez Nerea , Aguirre Urko , Baré Marisa , Escobar Antonio , Quintana José María ,   on behalf of the REDISSEC-CARESS/CCR Group, López Jose María Quintana , Mañas Marisa Baré , Bautista Maximino Redondo , de la Blanca Eduardo Briones Pérez , de Larrea Baz Nerea Fernández , Eizaguirre Cristina Sarasqueta , Martínez Antonio Escobar , Ruiz Francisco Rivas , Morales-Suárez-Varela Maria M. , Amaro Juan Antonio Blasco , del Cura González Isabel , Madariaga Inmaculada Arostegui , González Amaia Bilbao , Hernández Nerea González , García-Gutiérrez Susana , Guerrero Iratxe Lafuente , Larracoechea Urko Aguirre , Calzada Miren Orive , Corral Josune Martin , Antón-Ladislao Ane , Torà Núria , Pont Marina , del Prado María Purificación Martínez , Totorikaguena Alberto Loizate , Estévez Ignacio Zabalza , Alustiza José Errasti , Gimeno García Antonio Z. , Aramburu Santiago Lázaro , Serrano Mercè Comas , Navascues Jose María Enríquez , Galán Carlos Placer , Antón Amaia Perales , Valmaña Iñaki Urkidi , Azkárate Jose María Erro , Lizarribar Enrique Cormenzana , Muñoa Adelaida Lacasta , Pibernat Pep Piera , Cuevas Elena Campano , Gómez Ana Isabel Sotelo , Gómez-Abril Segundo , Medina-Cano F. , Alcaide Julia , Del Rey-Moreno Arturo , Alcántara Manuel Jesús , Campo Rafael , Casalots Alex , Pericay Carles , Gil Maria José , Pera Miquel , Collera Pablo , Espinàs Josep Alfons , Martínez Mercedes , Espallargues Mireia , Almazán Caridad , Lindenbaum Paula Dujovne , Fernández-Cebrián José María , Fernández Rocío Anula , Martínez Julio Mayol , Cid Ramón Cantero , Labajo Héctor Guadalajara , Garceau María Alexandra Heras , Olmo Damián García , Montalvo Mariel Morey 
Published: August 2020

Abstract
Background
Few studies have examined gender differences in the clinical management of rectal cancer. We examine differences in stage at diagnosis and preoperative radiotherapy in rectal cancer patients.

Methods
A prospective cohort study was conducted in 22 hospitals in Spain including 770 patients undergoing surgery for rectal cancer. Study outcomes were disseminated disease at diagnosis and receiving preoperative radiotherapy. Age, comorbidity, referral from a screening program, diagnostic delay, distance from the anal verge, and tumor depth were considered as factors that might explain gender differences in these outcomes.

Results
Women were more likely to be diagnosed with disseminated disease among those referred from screening (odds ratio, confidence interval 95% (OR, CI = 7.2, 0.9–55.8) and among those with a diagnostic delay greater than 3 months (OR, CI = 5.1, 1.2–21.6). Women were less likely to receive preoperative radiotherapy if they were younger than 65 years of age (OR, CI = 0.6, 0.3–1.0) and if their tumors were cT3 or cT4 (OR, CI = 0.5, 0.4–0.7).

Conclusions
The gender-specific sensitivity of rectal cancer screening tests, gender differences in referrals and clinical reasons for not prescribing preoperative radiotherapy in women should be further examined. If these gender differences are not clinically justifiable, their elimination might enhance survival.