Gender Differences in Urothelial Bladder Cancer. Effects of Natural Killer Lymphocyte Immunity

Abstract

Men are more likely to develop cancer than women. In fact, male predominance is one of the most consistent cancer epidemiology findings. Additionally, men have a poorer prognosis and an increased risk of secondary malignancies compared to women. These differences have been investigated in order to better understand cancer and to better treat both men and women. In this review, we discuss factors that may cause this gender difference, focusing on urothelial bladder cancer (UBC) pathogenesis. We consider physiological factors that may cause higher male cancer rates, including differences in X chromosome gene expression. We discuss how androgens may promote bladder cancer development directly by stimulating bladder urothelium and indirectly by suppressing immunity. We are particularly interested in natural killer (NK) cells because they are important, but often overlooked anti-cancer lymphocytes.

Sex differences in treatment patterns for non-advanced muscle-invasive bladder cancer: a descriptive analysis of 3484 patients of the Netherlands Cancer Registry

“…Although women have worse survival rates even after adjusting for disease stage at diagnosis, this excess mortality is present only in the first 2 years after diagnosis, thereafter the mortality rate of women is lower than that of men [4,6,11,12]. According to an analysis of the SEER database between 1990 and 2005, differences in prognostic factors such as age, tumor stage, grade and histological type account only for about 30% of the sex differences in BC mortality [11], suggesting that other factors such as differences in tumor biology, choice and efficacy of treatments and delay in treatment could contribute to this excess female mortality [12,13].…”