Gender-specific Differences in Clinicopathologic Outcomes Following Radical Cystectomy: An International Multi-institutional Study of More Than 8000 Patients
Kluth LA1, Rieken M2, Xylinas E3, Kent M4, Rink M5, Rouprêt M6, Sharifi N5, Jamzadeh A7, Kassouf W8, Kaushik D9, Boorjian SA9, Roghmann F10, Noldus J10, Masson-Lecomte A11, Vordos D11, Ikeda M12, Matsumoto K12, Hagiwara M13, Kikuchi E13, Fradet Y14, Izawa J15, Rendon R16, Fairey A17, Lotan Y18, Bachmann A19, Zerbib M20, Fisch M5, Scherr DS7, Vickers A4, Shariat SF21. Eur Urol. 2013 Dec 5. pii: S0302-2838(13)01302-X. doi: 10.1016/j.eururo.2013.11.040. [Epub ahead of print]

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1Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany. 2Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Hospital Basel, Basel, Switzerland. 3Department 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. 4Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 5Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany. 6Academic Department of Urology of la Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, University Paris VI, Faculté de médecine Pierre et Marie Curie, Paris, France. 7Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA. 8Department of Urology, McGill University, Montreal, QC, Canada. 9Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA. 10Department of Urology, Ruhr University Bochum, Marienhospital, Herne, Germany. 11Department of Urology, Hôpital Henri Mondor Créteil, Créteil, France. 12Department of Urology, Kitasato University School of Medicine, Minami-ku, Sagamihara, Kanagawa, Japan. 13Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan. 14Department of Surgery (Urology), Laval University, Quebec, QC, Canada. 15Department of Surgery (Urology), University of Western Ontario, London, ON, Canada. 16Department Urology, Dalhousie University, Halifax, NS, Canada. 17Department of Surgery (Urology), University of Alberta, Edmonton, AB, Canada. 18Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 19Department of Urology, University Hospital Basel, Basel, Switzerland. 20Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France. 21Department 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.