Is there a gender effect in bladder cancer?: A population-based study of practice and outcomes.

Abstract

Introduction: The incidence of bladder cancer varies by gender. Whether differences exist between women and men in extent of disease, treatment, and outcome is not well-described. We evaluate gender differences in bladder cancer using a population-based cohort. Methods: Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients with bladder cancer treated with cystectomy or radical radiotherapy (RT) in Ontario between 1994 and 2008. We compare extent of disease at time of cystectomy, treatment, and outcomes between women and men. Results: In total, 5259 patients with bladder cancer were treated with cystectomy or radical RT; of these, 25% (n = 1296) were women. There was no gender difference in the proportion of patients treated with cystectomy (75% of women [974/1296], 73% of men [2905/3963], p = 0.189). At the time of cystectomy, women were more likely to have muscle-invasive disease (86% [836/974] vs. 80% [2335/2905], p < 0.001), but less likely to have lymph nodes dissected (68% [664/974] vs. 76% [2210/2905], p < 0.001]. Among the 2944 patients with muscle-invasive urothelial carcinoma treated with cystectomy, use of neoadjuvant (5% vs. 4%, p = 0.419) and adjuvant chemotherapy (18% vs. 20%, p = 0.190) did not differ significantly between genders. Five-year cancer-specific survival and overall survival of the full cohort did not differ between women and men (38% vs. 39%, p = 0.522; 33% vs. 33%, p = 0.795). Conclusions: This population-based cohort did not demonstrate any substantial differences in extent of disease, treatment, or outcome between women and men treated with cystectomy or radical RT for bladder cancer.

Sex Differences in Urothelial Bladder Cancer Survival

“…27 A few exceptions to the notion of a female survival disadvantage in UBC do exist. 10,28,29 A population-based study from Estonia found men and women to have comparable UBC stage distribution and survival. 28 Similar findings were reported in a Canadian study, which was limited to patients undergoing radical cystectomy or radiotherapy in Ontario.…”

“…28 Similar findings were reported in a Canadian study, which was limited to patients undergoing radical cystectomy or radiotherapy in Ontario. 29 The adverse stage distribution suggests more aggressive tumor behavior in women. We found no evidence of this.…”

“…Sex differences regarding complications to radical cystectomy have been studied, but these deserve to be explored further in larger study populations. 9,29,31 T4 tumors were marginally more common but carried an extremely poor outcome in women, with a mortality rate close to metastasized UBC. Tumor involvement of the prostatic urethra without prostate stromal invasion can mistakenly be classified as T4 in men, contributing to the excessive survival imbalance.…”

Bladder cancer in women: a Sri Lankan study

“…Studies have shown that a significantly greater proportion of women are diagnosed at an advanced stage compared with men [24,25]. A large population based study of 5259 patients showed that women were more likely to have muscle-invasive disease at the time of cystectomy [26]. Analysis of all primary UBC patients reported to Swedish National Registry from 1997 to 2011 (30,310 patients) showed a greater proportion of women than men had muscle-invasive disease (stage T2-T4) at presentation (28.6% vs 24.9%, p<0.001) [27].…”

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

“…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.…”