28 Furthermore, the relative sex difference in the incidence of gastric cancer has an increasing trend, with male-to-female ratios rising from 1.86 in 1990 to 2.20 in 2017. 75 However, a study by Kim and colleagues (2016) showed that the female sex is a poor prognostic factor for advanced gastric cancer. 76 Additionally, females also have an inferior 5-year relative survival. 77 The selective protective effect of MPO polymorphism on males but not on females may be one of the mechanisms that cause poorer prognosis in females by maintaining the catalytic function of MPO in the context of gastric cancer.
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