OBJECTIVE: To investigate the associations of a range of personal and clinical variables with bladder cancer survival in men and women in NSW to see if we could explain why bladder cancer survival is consistently poorer in women than in men.
PATIENTS AND METHODS: All 6,880 cases of bladder cancers diagnosed in NSW between 2000 and 2008 were linked to hospital separation data and to deaths. Separate Cox proportional hazards regression models of hazard of bladder cancer death were constructed in those who did or did not undergo cystectomy.
RESULTS: Sixteen per cent of bladder cancer patients underwent cystectomy (16 per cent of men and 15 per cent of women). Women who underwent cystectomy were 26 per cent more likely to die than men (Hazard Ratio (HR) 1.26 95% confidence interval, CI 1.00-1.59) after adjustment for age, stage, time from diagnosis to cystectomy, distance from treatment facility and country of birth. None of these covariates had a material effect on the difference in hazard between women and men. However, when stratified by a history of cystitis, the adjusted hazard was 55 per cent higher in women (HR 1.55, 95%CI 1.15-2.10) than men with a history of cystitis while, in the absence of this history, there was no difference in the hazard between men and women (HR 0.99, 95%CI 0.57-1.70). This apparent modification of the effect of sex on bladder cancer outcome was not seen in patients treated only by resection: the adjusted HRs in women relative to men were 1.10 (95% CI 0.92-1.31) in those with a history of cystitis and 1.21 (95% CI 0.98-1.50) in those without. History of haematuria did not modify appreciably the association of sex with bladder cancer outcome.
CONCLUSIONS: Women's poorer survival from bladder cancer than men's remains unexplained. The possibility, however, that some factor associated with a history of cystitis may contribute to or explain the poorer outcome in women merits further investigation.
Written by:
Tracey E, Watt H, Currow D, Young J, Armstrong B. Are you the author?
The University of Sydney, New South Wales (NSW) Sydney, NSW.
Reference: BJU Int. 2013 Oct 15. Epub ahead of print.
doi: 10.1111/bju.12496
PubMed Abstract
PMID: 24127730
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