Gender and Mortality after Radical Cystectomy: Competing Risk Analysis

Abstract

Background: Data on the impact of gender on mortality after radical cystectomy is conflicting. We investigated a large single center sample with long-term follow-up in order to determine the relationship between gender and outcome. Patients and Methods: A total of 1,184 consecutive patients who underwent radical cystectomy for high risk superficial or muscle-invasive urothelial or undifferentiated bladder cancer between 1993 and 2015 were stratified by gender. Demographic data was compared using Mann-Whitney U test, chi-square test, or Fisher exact test. Cox proportional hazard models were used for the analysis of competing risks and logit models were used for the prediction of the receipt of adjuvant cisplatin-based chemotherapy. Results: Female patients were older, healthier, less frequently current smokers and had more extravesical tumors. In the multivariate analyses, female gender was an independent predictor of (lower) non-bladder cancer (competing) mortality (hazards ratio [HR] 0.68, 95% CI 0.49–0.95, p = 0.0248) but no predictor of bladder cancer-specific mortality (HR in the full model 1.20, 95% CI 0.94–1.54, p = 0.15). Gender was no predictor of the receipt of adjuvant cisplatin-based chemotherapy. Conclusions: Female gender was associated with an increased risk of extravesical disease but was no independent predictor of bladder cancer-specific mortality. Anatomical differences might be a plausible explanation for these observations.

The association between gender, stage and prognosis in bladder cancer patients undergoing radical cystectomy

“…The results of this study are consistent with other studies examining the impact of gender on oncological outcomes in BC patients treated with RC. Thus, Heberling et al [6] found female patients to be less comorbid and more likely to have extravesical tumors ( T3) similarly to our findings presented in Table 1. Likewise, Rosiello et al [7] found female gender to be an independent predictor of non-OC disease at the time of RC (OR ¼ 1.23, p < 0.001).…”

“…The risk of being comorbid increases with age, and the fact that the female patients in this study are less comorbid could partly be due to their younger age compared to the male patients (69 vs. 71 years). However, the female patients in both Heberling et al [6] and Rosiello et al [7] were significantly older than the male patients.…”

Жіноча Стать Як Фактор Прогнозу Виживаності Хворих На Низькодиференційований Рак Сечового Міхура Після Хірургічного Лікування

“…Виживаність через 5 років після встановлення діагнозу у жінок порівняно з чоловіками становить для стадії І 93,7 проти 96,5%, для стадії ІI -59,6 проти 65,5%, для стадії ІII -49,6 проти 58,8%, для стадії IV -15,2 проти 27,1% [18]. Проте в інших публікаціях ситуація із захворюваністю жінок на РСМ представлена більш оптимістично [1,8,20]. Зокрема, R. Pichler та співавтори вказали, що жіноча стать не є причиною гіршого прогнозу виживаності, але є фактором розвитку місцево-поширеного РСМ (стадія рТ3) та виконання гетеротопічного відведення сечі після радикальної цистектомії.…”

Das Harnblasenkarzinom der Frau

“…Dennoch gibt es hierzu inkonsistente Ergebnisse [1]. Heberling et al [24] untersuchten in einer monozentrischen retrospektiven Studie insgesamt 1184 Patienten, die sich zwischen 1993 und 2015 wegen eines "high-risk" NMIBC oder eines MIBC einer RC unterzogen hatten. Der Faktor weibliches Geschlecht war hier zwar mit einem erhöhten Risiko eines extravesikalen Stadiums vergesellschaftet, aber der Parameter weibliches Geschlecht war in der multivariaten Analyse kein unabhängiger Faktor für die krebsspezifische Mortalität (HR: 1,20, 95 %-KI: 0,94-1,54, p = 0,15).…”