Luis A Kluth1, Malte Rieken2, Evanguelos Xylinas3, Matthew Kent4, Michael Rink5, Morgan Rouprêt6, Nasim Sharifi5, Asha Jamzadeh7, Wassim Kassouf8, Dharam Kaushik9, Stephen A Boorjian9, Florian Roghmann10, Joachim Noldus10, Alexandra Masson-Lecomte11, Dimitri Vordos11, Masaomi Ikeda12, Kazumasa Matsumoto12, Masayuki Hagiwara13, Eiji Kikuchi13, Yves Fradet14, Jonathan Izawa15, Ricardo Rendon16, Adrian Fairey17, Yair Lotan18, Alexander Bachmann19, Marc Zerbib20, Margit Fisch5, Douglas S Scherr7, Andrew Vickers4, Shahrokh F Shariat21. 1. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Hospital Basel, Basel, Switzerland. 3. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France. 4. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 5. Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany. 6. Academic Department of Urology of la Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, University Paris VI, Faculté de médecine Pierre et Marie Curie, Paris, France. 7. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA. 8. Department of Urology, McGill University, Montreal, QC, Canada. 9. Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA. 10. Department of Urology, Ruhr University Bochum, Marienhospital, Herne, Germany. 11. Department of Urology, Hôpital Henri Mondor Créteil, Créteil, France. 12. Department of Urology, Kitasato University School of Medicine, Minami-ku, Sagamihara, Kanagawa, Japan. 13. Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan. 14. Department of Surgery (Urology), Laval University, Quebec, QC, Canada. 15. Department of Surgery (Urology), University of Western Ontario, London, ON, Canada. 16. Department Urology, Dalhousie University, Halifax, NS, Canada. 17. Department of Surgery (Urology), University of Alberta, Edmonton, AB, Canada. 18. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 19. Department of Urology, University Hospital Basel, Basel, Switzerland. 20. Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France. 21. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Division of Medical Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna, Austria. Electronic address: sfshariat@gmail.com.
Abstract
BACKGROUND: The impact of gender on the staging and prognosis of urothelial carcinoma of the bladder (UCB) is insufficiently understood. OBJECTIVE: To assess gender-specific differences in pathologic factors and survival of UCB patients treated with radical cystectomy (RC). DESIGN, SETTING, AND PARTICIPANTS: Data from 8102 patients treated with RC (6497 men [80%] and 1605 women [20%]) for UCB between 1971 and 2012 were analyzed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable competing-risk regression analyses were performed to evaluate the relationship of gender on disease recurrence (DR) and cancer-specific mortality (CSM). We also tested the interaction of gender and tumor stage, nodal status, and lymphovascular invasion (LVI). RESULTS AND LIMITATIONS: Female patients were older at the time of RC (p=0.033) and had higher rates of pathologic stage T3/T4 disease (p<0.001). In univariable, but not in multivariable analysis, female gender was associated with a higher risk of DR (p=0.022 and p=0.11, respectively). Female gender was an independent predictor for CSM (p=0.004). We did not find a significant interaction between gender and stage, nodal metastasis, or LVI (all p values >0.05). CONCLUSIONS: We found female gender to be associated with a higher risk of CSM following RC. However, these findings do not appear to be explained by gender differences in pathologic stage, nodal status, or LVI. This gender disparity may be due to differences in care and/or the biology of UCB.
BACKGROUND: The impact of gender on the staging and prognosis of urothelial carcinoma of the bladder (UCB) is insufficiently understood. OBJECTIVE: To assess gender-specific differences in pathologic factors and survival of UCB patients treated with radical cystectomy (RC). DESIGN, SETTING, AND PARTICIPANTS: Data from 8102 patients treated with RC (6497 men [80%] and 1605 women [20%]) for UCB between 1971 and 2012 were analyzed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable competing-risk regression analyses were performed to evaluate the relationship of gender on disease recurrence (DR) and cancer-specific mortality (CSM). We also tested the interaction of gender and tumor stage, nodal status, and lymphovascular invasion (LVI). RESULTS AND LIMITATIONS: Female patients were older at the time of RC (p=0.033) and had higher rates of pathologic stage T3/T4 disease (p<0.001). In univariable, but not in multivariable analysis, female gender was associated with a higher risk of DR (p=0.022 and p=0.11, respectively). Female gender was an independent predictor for CSM (p=0.004). We did not find a significant interaction between gender and stage, nodal metastasis, or LVI (all p values >0.05). CONCLUSIONS: We found female gender to be associated with a higher risk of CSM following RC. However, these findings do not appear to be explained by gender differences in pathologic stage, nodal status, or LVI. This gender disparity may be due to differences in care and/or the biology of UCB.
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