The impact of female gender on bladder cancer-specific death risk after radical cystectomy: a meta-analysis of 27,912 patients

Liu, Shenghua; Yang, Tian; Na, Rong; Hu, Mengbo; Zhang, Limin; Fu, Yuli; Jiang, Haowen; Ding, Qiang

doi:10.1007/s11255-015-0980-6

Cited by 27 publications

(13 citation statements)

References 36 publications

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“…Anatomical differences might also explain the fact that a higher mortality in females with bladder cancer contrasts to a lower mortality in females seen in a great variety of other cancers [14]. The results of this study do not support the hypothesis that female candidates for radical cystectomy should undergo more intense treatment and follow-up [2] since the stage-adjusted mortality rates did not differ meaningfully (Table 2; Fig. 2).…”

Section: Gender and Mortality After Radical Cystectomymentioning

confidence: 56%

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Gender and Mortality after Radical Cystectomy: Competing Risk Analysis

Heberling

Koch

Hübler³

et al. 2018

Urol Int

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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.

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Section: Gender and Mortality After Radical Cystectomymentioning

confidence: 56%

“…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

Urol Int

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“…This is consistent with Siergrist et al, which found that gender was not a significant predictor of the rate of both major (Clavien grade 3-5) and minor (Clavien grade 1 or 2) complications in the perioperative period [25]. However, a recent meta-analysis of 17 studies showed female gender is associated with a higher rate of cancer specific death (CSD), which we are not able to investigate this finding due to the limitations of the NSQIP database [26]. Previously it has been suggested this gender difference is due to women presenting with more advanced disease along with sociodemographic differences and the association of gender with CSD disappears when controlling for these confounders [27].…”

Section: 4 Discussionmentioning

confidence: 92%

Frailty as a marker of adverse outcomes in patients with bladder cancer undergoing radical cystectomy

Chappidi

Kates

Patel

et al. 2016

Urologic Oncology: Seminars and Original Investigations

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Objective To investigate the modified frailty index (mFI) as a pre-operative predictor of post-operative complications following radical cystectomy in bladder cancer patients. Materials and Methods Patients undergoing radical cystectomy (RC) were identified from the National Surgical Quality Improvement Program (NSQIP) participant use files (2011-2013). The mFI was defined in prior studies with 11 variables based on mapping the Canadian Study of Health and Aging Frailty Index to NSQIP comorbidities and activities of daily living (ADL)s. Modified frailty index groups were determined by the number of risk factors per patient (0, 1, 2, ≥3). Univariate, χ2, independent sample t-test, and logistic regression analyses were performed when appropriate. A sensitivity analysis was performed to determine the mFI value at which Clavien 4 and 5 complications would reach significance. Results Of the 2679 cystectomy patients identified, 31% percent of patients had a mFI of 0, 44% had a mFI of 1, 21% had a mFI of 2, and 4% had a mFI ≥ 3. Overall, 59% of patients experienced a Clavien complication. When stratified at a cutoff of mFI >=2, the overall complication rate was not different (61.7% vs. 58.3%, p=0.1319), but the mFI2 or greater group had a significantly higher rate of Clavien grade 4 or 5 complications (14.6% vs. 8.3%, p<0.001) and overall mortality rate (3.5% vs. 1.8%, p=0.0128) in the 30-day post-operative period. The multivariate logistic regression model showed independent predictors of Clavien grade 4 or 5 complications were age >80 years old (OR, 1.58 [1.11-2.27]), mFI2 (odds ratio [OR], 1.84 [1.28-2.64]), and mFI3 (OR, 2.58 [1.47-4.55]). Conclusions Among patients undergoing radical cystectomy, the mFI can identify those patients at greatest risk for severe complications and mortality. Given that bladder cancer is increasing in prevalence particularly among the elderly, pre-operative risk stratification is crucial to inform decision making about surgical candidacy.

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“…However, whether this translates into worse survival rates is still debatable. While a metaanalysis of nearly 28,000 patients showed a worse survival in women compared to men [3], several other studies showed no difference in recurrence-free or survival rates [4,5]. Moreover, survival and recurrence data on non-Caucasians patients are scarce.…”

Section: Introductionmentioning

confidence: 99%

Detailed clinical data of The Cancer Genome Atlas muscle-invasive bladder cancer database with focus on gender and ethnic stratification

Nativ¹,

Halachmi²,

Ghantous³

et al. 2018

A Rare Benign Lesion in the Lung: Clear Cell “Sugar” Tumor (CCST)

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Introduction: Bladder cancer is one of the most common neoplasms, especially in men. About 25% of the patients present with the more aggressive type of bladder cancer, the muscle-invasive type, which carries a significant risk of death. The Cancer Genome Atlas (TCGA) had recently published extensive genomic data of 412 muscle-invasive bladder cancer (MIBC) patients, with modest clinical information. The aim of the current study was to analyze several aspects of the clinical data of TCGA bladder cancer database. Methods: Using NCI Genomic Data Commons portal and cBioPortal, we extracted data on 412 patients with MIBC from the TCGA database. We then analyzed and statistically compared these data using different statistical methods. Aside from clinical data, we also extracted data on disease-free and overall survival. Results: The database included 104 female patients and 297 male patients. The vast majority were Caucasians (79.0%), followed by Asians (11%) and African-Americans (5.5%). The female group was older than the male group (70.0 vs 67.3 years, P=0.02). Incidental prostate cancer was seen in 82 male patients (27.6%). Kaplan-Meier curves for disease-free survival and overall survival showed no difference between male and female patients, and no difference between the three ethnics groups. Conclusions: TCGA provides an invaluable source for genomic alterations of MIBC. In this study, we have shown that it also provides adequate clinical information that can be compared with genomic data and future studies. No statistically significant differences were shown in disease-free and overall survival between male and female patients in the TCGA MIBC database.

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The impact of female gender on bladder cancer-specific death risk after radical cystectomy: a meta-analysis of 27,912 patients

Abstract: Female demonstrated worse survival outcomes than male after radical cystectomy for bladder cancer. The adoption of more intense cares for female patients was suggested after radical cystectomy.

Cited by 27 publications

References 36 publications

Gender and Mortality after Radical Cystectomy: Competing Risk Analysis

Gender and Mortality after Radical Cystectomy: Competing Risk Analysis

Frailty as a marker of adverse outcomes in patients with bladder cancer undergoing radical cystectomy

Detailed clinical data of The Cancer Genome Atlas muscle-invasive bladder cancer database with focus on gender and ethnic stratification

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