Sex-Based Differences in Clinicopathologic Features and Survival Outcomes in Colon Cancer

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Objective:Sex-related differences in the epidemiology and clinical behavior of colon cancer have gained increasing attention, yet existing findings remain inconsistent. This study aimed to compare demographic, clinicopathologic characteristics and survival outcomes between female and male patients with colon cancer using a large population-based cohort from the SEER database.Methods:This retrospective cohort study included adults diagnosed with colon cancer between 2010-2021 in the Surveillance, Epidemiology, and End Results(SEER) program. Cases with appendiceal or rectal tumors, diagnosis by autopsy or death certificate, missing sex information, or incomplete survival data were excluded. Demographic and tumor-related variables were compared using the chi-square test. Overall survival(OS) and cancer-specific survival(CSS) were estimated with Kaplan-Meier analysis and compared using the log-rank test. Cox proportional hazards models were applied to evaluate the independent effect of sex on survival.Results:A total of 314,706 patients were included(154,387 women;160,319 men). Women were older at diagnosis and more frequently had right-sided tumors, mucinous histology, and high-grade disease. Men more often presented with stage IV disease and had higher rates of cardiovascular and other-cause mortality. OS favored women across all time points(10-year OS:37.6%vs.35.7%), while long-term CSS was similar(10-year CSS:62.8%vs.62.6%). In multivariable analyses, male sex remained an independent adverse prognostic factor for OS (HR 1.21) and CSS (HR 1.10).Conclusion:This large-scale population-based analysis demonstrates clear sex-related differences in the presentation and prognosis of colon cancer. Male sex is an independent predictor of poorer survival, underscoring the need for sex-sensitive and individualized management strategies.