Female sex is an independent risk factor for reduced overall survival in bladder cancer patients treated by transurethral resection and radio- or radiochemotherapy

Keck, Bastian; Ott, Oliver J.; Häberle, Lothar; Kunath, Frank; Weiß, Christian; Rödel, Claus; Sauer, Rolf; Fietkau, Rainer; Wullich, Bernd; Krause, F

doi:10.1007/s00345-012-0971-5

Cited by 24 publications

(22 citation statements)

References 22 publications

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“…In non-muscle-invasive bladder cancer, Kluth et al [14] reported that female gender was associated with a higher risk of disease recurrence. Similar findings were observed by the Club Urológico Español de Tratamiento Oncológico [15], Palou et al [16] and Keck et al [17], who demonstrated that female gender was an independent predictor of disease recurrence, progression and impaired overall survival. On the other hand, Sylvester et al [18] did not find an independent impact of gender within EORTC trials comprising roughly 2,600 patients with Ta or T1 non-muscle-invasive bladder cancer after TUR-BT.…”

Section: Discussionsupporting

confidence: 71%

Comparative Analysis of Gender-Related Differences in Symptoms and Referral Patterns prior to Initial Diagnosis of Urothelial Carcinoma of the Bladder: A Prospective Cohort Study

et al. 2014

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Objective: To analyze gender-specific differences regarding clinical symptoms, referral patterns and tumor biology prior to initial diagnosis of urothelial carcinoma of the bladder (UCB). Methods: A consecutive series of patients with an initial diagnosis of UCB was included. All patients completed a questionnaire on demographics, clinical symptoms and referral patterns. Results: In total, 68 patients (50 men, 18 women) with newly diagnosed UCB at admission for transurethral resection of bladder tumors were recruited. Dysuria was more often observed in women (55.6 vs. 38.0%, p = 0.001). Direct consultation of the urologist was conducted by 84.0% of males and 66.7% of females (p = 0.120). One third of the women saw their general practitioner and/or gynecologist once or twice (p = 0.120) before referral to the urologist. Furthermore, women were significantly more often treated for urinary tract infections than men (61.1 vs. 20.0%, p = 0.005). Cystoscopy at first presentation to the urologist was more often performed in men than women (88.0 vs. 66.7%, p = 0.068), with a more favorable tumor detection rate at first cystoscopy in men (96.0 vs. 50.0%, p < 0.001). Conclusions: Delayed referral patterns might lead to deferred diagnosis of UCB and consequently to adverse outcome. Thus, primary care physicians might consider referring patients with bladder complaints to specialized care earlier.

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Section: Discussionsupporting

confidence: 71%

Comparative Analysis of Gender-Related Differences in Symptoms and Referral Patterns prior to Initial Diagnosis of Urothelial Carcinoma of the Bladder: A Prospective Cohort Study

et al. 2014

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“…In this series, the median overall survival was 5.1 years for men versus only 2.3 years for women (p = 0.045) [17]. The estimated median cancer-specific survival was 7.1 years for female versus 12.7 years for male patients [17]. …”

Section: Discussionmentioning

confidence: 99%

“…However, they present with more advanced tumours, thus explaining the observation of poor outcomes in an unmatched cohort. Keck et al analysed the impact of gender on the outcome of invasive bladder cancer managed by a multimodal bladder sparing approach in 105 female and 386 male patients [17]. In this series, the median overall survival was 5.1 years for men versus only 2.3 years for women (p = 0.045) [17].…”

Section: Discussionmentioning

confidence: 99%

“…Keck et al analysed the impact of gender on the outcome of invasive bladder cancer managed by a multimodal bladder sparing approach in 105 female and 386 male patients [17]. In this series, the median overall survival was 5.1 years for men versus only 2.3 years for women (p = 0.045) [17]. The estimated median cancer-specific survival was 7.1 years for female versus 12.7 years for male patients [17].…”

Section: Discussionmentioning

confidence: 99%

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Sex Differences of ≥pT1 Bladder Cancer Survival in Austria: A Descriptive, Long-Term, Nation-Wide Analysis Based on 27,773 Patients

Waldhoer¹,

Berger²,

Haidinger³

et al. 2015

Urol Int

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Introduction: In recent days, the relationship between gender, tumour stage and survival of bladder cancer has attracted interest. Materials and Methods: The Austrian cancer registry was linked to the national death statistics. All patients with urothelial cancer of the urinary bladder with stages pT1, pT2, pT3 and pT4 diagnosed between 1983 until 2012 were followed for up to 15 years. Overall and cancer-specific mortality were estimated by cumulative incidence. Results: A total of 27,773 patients were analysed. The male:female ratio declined from 3:1 for stage pT1-tumours (n = 16,416) to 2.6:1 for pT2 (n = 6,548), 2.1:1 for pT3 (n = 3,111) and 1.9:1 for pT4 (n = 1,698). The 5 years cumulative overall death rate for pT1 tumours was slightly lower for women (0.31 vs. 0.32; p = 0.016). The opposite was observed for more advanced tumour stages: pT2: women 0.66, men: 0.60 (p = 0.0001); pT3: women 0.76, men 0.72 (p = 0.0004) and for pT4: women 0.90, men 0.85 (p = 0.0001). Cancer-specific survival was identical for pT1-tumours in both sexes, while women had a worse cancer-specific survival in both age cohorts (<70 years and ≥70 years) with higher tumour stages. Conclusions: This population-based study demonstrates that (1) a rise of advanced bladder cancer stages in women and (2) that women with tumour stages >pT1 have a shorter cancer-specific and overall survival.

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“…Burger et al [14] recognised the research gap of gender in urology and therefore analysed existing descriptions of gender effects in general oncological and uro-oncological research. Keck et al [15] evaluate sex as a possible prognostic factor in bladder cancer patients treated by transurethral resection and radio-or radiochemotherapy. Brookman-May et al [16] demonstrate the importance of gender differences in clinical and pathological features as well as the outcomes of patients with renal cell carcinoma after surgery.…”

mentioning

confidence: 99%

Gender in urology

2013

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The sex-gender debate has emerged from the USA as a political movement of the late 1960s and 1970s and addressed the question: What makes a woman a woman and what makes a man a man? Biological conditions (sex) or sociocultural aspects (gender)?However, the concept of gender, especially the importance of a proper understanding of the sex/gender relations, did not find entrance into the medical discourse until the twenty-first century when the medical community discovered that 'women are not small men' and that medicine, therapeutic strategies, medication and most diagnostics were aimed and proofed only at men [1]. The aspirin story elucidates the importance of gender issues. In the US physician study, aspirin showed an outstanding protective effect in cardiovascular system, and the study was discontinued due to ethical factors [2]. Since that time, aspirin was the most sold medicine worldwide; however, it was not tested in a single woman. Today, we know that aspirin only reduced the risk of stroke, but not of myocardial infarction in women [3]. After checking for gender, aspirin is only recommended to high-risk female patient under the age of 65 years [4].The need to regard differences and similarities in men and women as medical research and clinical practice leads to the formation of a 'personalised medicine' that not only considers all individual risk factors of a human being (e.g. race, ethnicity, lifestyle factors, personal history, genetic predisposition) but also acknowledges gender-and sexrelated differences in health behaviour, aetiopathogenesis and treatment [5].Nonetheless, it is still a challenge to define gender medicine clearly: the theoretical problem lies in the juxtaposition between gender as a sociocultural process and medical and therefore biological hypotheses-despite the initial ambition of gender-related research to separate the two terms and their meaning.Yet, diseases are more sex-and gender-conditioned than long time expected. They have major consequences on the practice of medicine, on outcomes and on choice and efficacy of therapy [6]. At first, endocrine and reproductive systems were the logical areas to observe the effects of gender on medicine. But for some time now, it has been common sense that women and men also differ in diseases such as diabetes, various cardiovascular syndromes and many more [1].With that in mind, it is hardly surprising that urology plays a special role within gender medicine: among the urinary organs, urology states the male genital apparatus as explicit organ of its discipline. Non-professionals often call urology even the 'medicine for men', in contrast to gynaecology being the 'medicine for women'. To understand these attributions and to extend interdisciplinary coworking (in areas such as female urinary incontinence), it is important to integrate gender research as an inseparable component of the urologic field [7].The current World Journal of Urology's special issue acknowledges both the correlation of gender with urology and the significance of gender m...

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Female sex is an independent risk factor for reduced overall survival in bladder cancer patients treated by transurethral resection and radio- or radiochemotherapy

Cited by 24 publications

References 22 publications

Comparative Analysis of Gender-Related Differences in Symptoms and Referral Patterns prior to Initial Diagnosis of Urothelial Carcinoma of the Bladder: A Prospective Cohort Study

Comparative Analysis of Gender-Related Differences in Symptoms and Referral Patterns prior to Initial Diagnosis of Urothelial Carcinoma of the Bladder: A Prospective Cohort Study

Sex Differences of ≥pT1 Bladder Cancer Survival in Austria: A Descriptive, Long-Term, Nation-Wide Analysis Based on 27,773 Patients

Gender in urology

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