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Female gender is associated with higher risk of disease recurrence in patients with primary T1 high-grade urothelial carcinoma of the bladder |
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| Authors: | Luis A. Kluth Harun Fajkovic Evanguelos Xylinas Joseph J. Crivelli Niccolo Passoni Morgan Rouprêt Andreas Becker Evi Comploj Armin Pycha Sten Holmang Amit Gupta Yair Lotan Pierre I. Karakiewicz Paolo Gontero Felix K.-H. Chun Margit Fisch Douglas S. Scherr Shahrokh F. Shariat |
| Affiliation: | 1. Department of Urology, Weill Medical College of Cornell University, 525 East 68th Street, Starr 900, New York, NY, 10065, USA 3. Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany 4. Department of Urology, Landesklinikum St.Poelten, Sankt Poelten, Austria 5. Department of Urology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France 6. Department of Urology, Vita-Salute University, Milan, Italy 7. Academic Department of Urology of la Pitié-Salpétrière, Assistance Publique–H?pitaux de Paris, University Paris VI, Faculté de médicine Pierre et Marie Curie, Paris, France 8. Department of Urology, University of Montreal, Montreal, QC, Canada 9. Department of Urology, General Hospital of Bolzano, Bolzano, Italy 10. Department of Urology, Sahlgrenska University Hospital, G?teborg, Sweden 11. Department of Urology, University of Iowa, Iowa city, IA, USA 12. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA 13. Department of Urology, Molinette University Hospital, Turin, Italy 2. Division of Medical Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA |
| Abstract: | PurposeAn increasing body of evidence suggests gender differences in the presentation and prognosis of bladder cancer. We aimed to assess the impact of gender on outcomes in patients with primary T1 high-grade (HG) urothelial carcinoma of the bladder (UCB).MethodsWe retrospectively analysed the data from 916 patients with primary T1HG UCB from 7 tertiary care centres. Patients were treated with transurethral resection of the bladder with or without intravesical instillation therapy (IVT). Univariable and multivariable Cox regression analyses assessed the effect of gender on outcomes.ResultsWithin a median follow-up of 42.8 months, 365 (39.8 %) patients experienced disease recurrence, 104 (11.4 %) progression, 59 (6.4 %) cancer-specific mortality and 190 (20.7 %) mortality of any cause. Overall, 634 (69.2 %) patients received IVT of which 234 (25.5 %) received BCG therapy. Female gender (n = 190, 20.7 %) was associated with higher risk of disease recurrence (HR:1.359;1.071–1.724, p = 0.012) in all patients and in a subgroup of patients treated with BCG therapy (HR:1.717;1.101–2.677, p = 0.017). There was no difference between genders with regard to disease progression, cancer-specific mortality and any-cause mortality. In multivariable analyses that adjusted for the effects of concomitant carcinoma in situ (CIS), tumour size, number of tumours, and IVT, gender remained an independent predictor for disease recurrence (p = 0.026) when analysed in all patients, but not in the subgroup of BCG treated patients (p = 0.093).ConclusionsIn patients with T1HG UCB, female gender is associated with higher risk of disease recurrence, but not with disease progression. This gender disparity may be due to differences in care and/or biology of UCB. |
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