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

Abstract

Introduction: Our hospital is a tertiary medical center located in southern Taiwan, which is an endemic area for upper tract urothelial carcinoma (UTUC) cases. Using a large registry-based surgical database, we examined our cohort of patients with UTUC, and evaluated the treatment outcome and gender-specific differences in this population. Methods: A total of 506 patients with localized UTUC undergoing nephroureterectomy from 2004 to 2013 were enrolled. The patient, tumor, and treatment-related characteristics were prospectively recorded by the registry. Overall (OS) and cancer-specific (CSS) survival outcomes were evaluated as well. Gender differences as related to clinical and pathological factors were examined by chi-square testing. Univariate and multivariate Cox regression analyses were applied. Results: There were more female patients (57.9%) in this population. The median follow-up was 6.9 years for living patients. The actuarial 5-year OS and CSS rates were 69.4 and 84.9%, respectively. Being female, aged <70 years, and early T-stage were statistically significantly associated with better OS and CSS by multivariate analyses. The 5-year CSS rates for females vs. males were 89.6 and 78.5%, respectively ( P < 0.005). A subgroup analysis suggested that better survival outcomes for females only existed in the stage 0a/0is/I (non-muscle-invasive), but not in the advanced stage. Conclusions: In an endemic area, females were more likely diagnosed with UTUC, but had significantly improved OS and CSS compared to their male counterparts, which were mostly driven by the non-muscle-invasive cases. Future research should focus on better understanding the epidemiologic risk-factor profile and pathophysiologic differences based on gender.

Urothelial carcinoma and its association with age and gender.

“…[17][18][19] Though, even following adjustment for a few of these factors, the gender disparity in survival remained there. 12 We had suspected another factor for males, as smoking habits are frequent among males in contrast to females, this was also found among many studies that smoking is the commonest factor for urothelial carcinoma. 12,14,17 It is worth to note in all those studies that the males are most common as compared to females and it is also mentioned that smoking is commonest factor.…”

“…12 We had suspected another factor for males, as smoking habits are frequent among males in contrast to females, this was also found among many studies that smoking is the commonest factor for urothelial carcinoma. 12,14,17 It is worth to note in all those studies that the males are most common as compared to females and it is also mentioned that smoking is commonest factor. 12,14,17 Similarly in this study mostly males had smoking habits.…”

“…In recent times, many reviews have summarized and interpreted outcomes from published investigations on the gender disparity in prognosis of bladder malignancy. [12][13][14][15][16] Multiple factors are suspected to influence the gender specific prognostic outcome. 12,16 Distinctive anatomy, deferrals from the earliest symptoms to diagnosis among women, changes in hormone receptors in addition to tumor biology and less ideal treatment for females were proposed to contribute in the observed disparities.…”

“…[12][13][14][15][16] Multiple factors are suspected to influence the gender specific prognostic outcome. 12,16 Distinctive anatomy, deferrals from the earliest symptoms to diagnosis among women, changes in hormone receptors in addition to tumor biology and less ideal treatment for females were proposed to contribute in the observed disparities. [17][18][19] Though, even following adjustment for a few of these factors, the gender disparity in survival remained there.…”

“…1 Additionally, the correlation and effect of gender on bladder TCC prevalence, prognosis, staging, and survival are incompetently understood, 11 and by recent studies, it is recommended that further research should be done to the better understanding for epidemiological risk-factors and differences according to gender. 12 Therefore this study has been conducted to determine the urothelial carcinoma and its association with age and gender.…”