INTRODUCTION: Controversial findings regarding gender-specific oncological outcomes of urothelial carcinoma of the bladder (UCB) have recently been reported.
The aim of this study was to analyze gender-specific outcomes using a stage-adjusted approach in a homogenous, contemporary radical cystectomy (RC) cohort.
MATERIAL AND METHODS: We prospectively collected data of 517 UCB patients treated with RC and pelvic lymphadenectomy without neoadjuvant chemotherapy at our institution between 1996 and 2010. Stage-adjusted uni- and multivariable Cox regression models analyzed the association of gender with disease recurrence, cancer-specific mortality and overall survival.
RESULTS: In total, 398 (77%) patients were male and 119 (23%) were female. Compared to men, women were more likely to have advanced tumor stages (p = 0.017), nodal metastasis (p = 0.047) and received more frequently adjuvant chemotherapy (p = 0.009). At a median follow-up of 44 months, there was no statistical difference in disease recurrence, cancer-specific mortality and overall survival between both genders when analyzed as a group. In stage-adjusted analyses, only women with non-invasive UCB were more likely to die of UCB compared to the male counterparts (p = 0.013). In gender-specific multivariable analyses that adjusted for standard clinico-pathologic features, pathologic tumor stage was an independent predictor for disease recurrence (p-values ≤ 0.047) and cancer-specific mortality (p-values ≤ 0.049), respectively.
CONCLUSION: Women present with more aggressive tumor biologic features at RC, however this did not translate into inferior outcomes compared to men in stage-specific analyses in our cohort. Tumor stage is the most important factor influencing the course of disease in both genders. Validation of our findings is warranted in a larger cohort.
Written by:
Soave A, Dahlem R, Hansen J, Weisbach L, Minner S, Engel O, Kluth LA, Chun FK, Shariat SF, Fisch M, Rink M. Are you the author?
University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Department of Pathology, Hamburg, Germany; University Medical Center Vienna, Department of Urology, Vienna, Austria.
Reference: Eur J Surg Oncol. 2014 Mar 13. pii: S0748-7983(14)00348-5.
doi: 10.1016/j.ejso.2014.03.003
PubMed Abstract
PMID: 24674298
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