Age-specific effect of gender on upper tract urothelial carcinoma outcomes

Abstract

The research is to evaluate the age-specific differential effects of gender on outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Between August 1998 and October 2010, we retrospectively reviewed the data from 285 (67.7%) men and 136 (32.3%) women treated with RNU for UTUC at our two institutions. Kaplan-Meier survival estimates the age-specific effect of gender on cancer-specific survival (CSS). Cox proportional hazards regression analyses were used to address the effect of gender on CSS. No significant sex-related differences were found in age and diagnosis, clinicopathologic features, and treatment (all P values >0.05). Women had a 18.7% increased risk of death from UTUC than men (hazard ratio [HR] 1.187; 95% confidence interval [95% CI] 1.017-1.893; P = 0.021). The survival disadvantage was only present in patients aged 59 years and older (P < 0.001). Conversely, the survival advantage for women was found in women aged 42 to 58 years (P = 0.011) and in the age group <42 years (P = 0.019). On multivariable Cox regression analyses that adjusted for the effects of clinicopathologic features, the female gender was associated with decreased CSS (P = 0.036). In conclusion, the impact of gender on UTUC outcomes after RNU is age-specific. Females who aged 59 years and older experienced worse outcomes than their male counterparts, while women in the age group <42 years and 42-58 years have better outcomes than men. Further research is needed to elucidate the molecular mechanisms underlying the age-specific differential effect of gender on UTUC outcomes.

Gender Is a Significant Prognostic Factor for Upper Tract Urothelial Carcinoma: A Large Hospital-Based Cancer Registry Study in an Endemic Area

“…In Asia, one multicenter report (15) from Japan revealed that the number of males were 2.7 times that of females; in addition, a single institution's study (16) from Korea even reported that the males were nearly quadruple the females. In mainland China, one study from Guangzhou (17) also reported twice as many males as females; however, another patient population (18, 19) in Beijing revealed similar gender distribution such as ours.…”

Conditional Survival After Radical Nephroureterectomy for Upper Tract Carcinoma

“…However, no significant association has been identified between gender and CSS when assessing the initial postoperative risk [2]. Other studies have suggested that women could have decreased CSS when stratifying gender analyses by age or smoking habits [22,23]. Our findings highlighted that, although gender did not have an impact on CSS at baseline, female sex was an independent risk factor of poorer long-term CSS rates in >3-yr survivors.…”

Gender differences in incidence and outcomes of urothelial and kidney cancer

“…61 Similarly, Tanaka et al 62 reported male gender, together with tumour multifocality and positive urinary cyto logy, as independent risk factors for intravesical recurrence. Liu et al 63 found an increased risk of death from UTUC in women ≥59 years old compared with men of the same age (P <0.001), whereas women aged 42-58 years (P = 0.011) and <42 years (P = 0.019) had better CSS than men ( Figure 2). …”