J Cancer 2017; 8(17):3567-3574. doi:10.7150/jca.21130
Gender-related Outcome in Bladder Cancer Patients undergoing Radical Cystectomy
1. Department of Urology;
2. Department of Medical Statistics, Informatics and Health Economics;
3. Department of Clinical Epidemiology of the Tyrolean State Hospitals Ltd, Cancer Registry of Tyrol;
4. Department of Public Health, Health Services Research and HTA, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria;
5. Women's Health Centre and Coordination Centre for Equality, Affirmative Action for Women and Gender Research, Medical University of Innsbruck, A-6020 Innsbruck, Austria.
Pichler R, Fritz J, Heidegger I, Oberaigner W, Horninger W, Hochleitner M. Gender-related Outcome in Bladder Cancer Patients undergoing Radical Cystectomy. J Cancer 2017; 8(17):3567-3574. doi:10.7150/jca.21130. Available from http://www.jcancer.org/v08p3567.htm
Background: The impact of gender on oncological outcome after radical cystectomy (RC) is not fully understood yet. The aim of the study was to evaluate gender-related differences in histopathological parameters and prognosis of patients with bladder cancer undergoing RC.
Methods: A retrospective analysis of a 10-year single-center cystectomy database was performed. Kaplan-Meier survival and Cox-regression analyses with sex-specific interactions were performed to determine the impact of gender on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS), in addition to established clinicopathological factors.
Results: 259 patients (212 [81.8%] men and 47 [18.2%] women) were enrolled. Although women had a greater propensity for extravesical (≥pT3) disease (53.2% vs. 33.9%, p=0.03) and heterotopic urinary diversion (72.3% vs. 49.5%, p=0.006), gender did not independently predict RFS, CSS or OS on multivariate analysis. Extravesical tumor disease was the sole independent predictor concerning RFS (hazard ratio [HR]=4.70; p<0.001), CCS (HR=2.77; p=0.013), and OS (HR=1.93; p=0.041). Orthotopic urinary diversion (HR=0.36; p=0.002) had an independent effect only on RFS. Rates of 5-year RFS (73.7% vs. 48.3%; p=0.001), CSS (72.5% vs. 44.9%; p<0.001) and OS (62.6% vs. 37.8%; p<0.001) were higher in orthotopic versus heterotopic diversions.
Conclusion: In our series, women presented with more advanced tumors and higher rates of heterotopic urinary diversions, but their survival outcome was not significantly inferior to that of men. Extravesical disease was independently related to poorer survival after RC.
Keywords: bladder cancer, cystectomy, outcome, gender, survival, prognostic factor