Gender-specific Differences in Clinicopathologic Outcomes Following Radical Cystectomy: An International Multi-institutional Study of More Than 8000 Patients

Introduction and Objectives: Bladder cancer is characterized by gender-dependent disparities. To further address this issue, we analysed a prospective, multicentre cystectomy registry. Methods: An online database was developed that included patient demographics, intra/perioperative data, surgical data and in-house complications. Results: Four hundred fifty-eight patients (112 [24.5%] women and 346 [75.5%] men) were analysed. Men and women were comparable regarding age (mean 68 years), body mass index (mean 26.5) and the mean Charlson score (4.8). Women had more advanced tumour-stages (pT3/pT4; women: 57.1%; men: 48.1%). The rate of incontinent urinary diversion was higher in women (83.1%) than in men (60.2%) and in a multivariate analysis, the strongest predictors were M+ status (OR 11.2), female gender (OR 6.9) and age (OR 6.5). Women had a higher intraoperative blood transfusion rate. The overall rate of in-house complications was similar in both genders (men: 32.0%, women: 32.6%). Severe (Clavien-Dindo grade >2) medical (women: 6.3%; men: 5.2%) and surgical (women: 21.5%; men: 14.4%) in-house complications, however, were more frequent in women. Conclusions: This multicentre registry demonstrates several gender-related differences in patients undergoing radical cystectomy. The higher transfusion rate, the rare use of orthotopic bladder substitutes and the higher in-house complication rate underline the higher complexity of this procedure in women.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Impact of Gender on Tumour Stage in In-House Complications and Choice of Urinary Diversion: Results of the Austrian Cystectomy Registry

Gschliesser

Eredics²,

Berger³

et al. 2017

“…Worse outcomes for women following radical cystectomy are well documented [18,29,35,36,37,44,45] but these findings are refuted by Mitra et al [8.] Having intensively matched 414 female and male cystectomy patients for demographic, tumor and treatment characteristics, no significant difference in recurrence-free survival, cancer-specific survival or overall survival was found (p = 0.45, p = 0.34, p = 0.71, respectively).…”

Section: Does Response To Treatment Differ Between Genders? - What Ismentioning

confidence: 99%

Closing the Gender Gap: Can We Improve Bladder Cancer Survival in Women? - A Systematic Review of Diagnosis, Treatment and Outcomes

Burge

Kockelbergh

2016

Introduction: Despite recent attention, there are no gender specific guidelines to address the disparity in bladder cancer survival between the sexes. The focus of this review was to identify areas of clinical practice that may influence bladder cancer outcomes and to provide evidence-based recommendations to improve bladder cancer survival in women. Method: A systematic search of MEDLINE was conducted to identify studies related to referral, diagnosis, treatment and outcomes of patients with bladder cancer with particular reference to gender differences. Results: Patients' knowledge of key signs and symptoms of bladder cancer is poor. There is evidence that there is a gender difference in referral patterns both at patient and primary care level. The presence of cystits, in particular, delays referral. Treatment and surveillance of high-risk non-muscle invasive cancers is variable and non-urothelial bladder cancer, which has higher incidence in women is more likely to be treated non-operatively than urothelial bladder cancer. Conclusion: We have offered recommendations to improve patient education and streamline referrals and suggested considerations for treatment of high-risk cancers to help improve survival in female bladder cancer patients.

“…Female patients have been found to harbor a higher mortality risk after radical cystectomy [1][2][3]. The reasons for this phenomenon are discussed controversially [1].…”

Section: Introductionmentioning

confidence: 99%

Gender and Mortality after Radical Cystectomy: Competing Risk Analysis

Heberling

Koch

Hübler³

et al. 2018

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.