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] 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.

Gender and Mortality after Radical Cystectomy: Competing Risk Analysis

“…A somewhat greater age difference between males and females (1 year [3] vs. 3.1 years in this study) and a less favorable stage distribution in females are further demographic differences between the current and the cited study [3]. A similar difference between females and males concerning the presence of extravesical disease (T3-4, 58.7 vs. 47.2% [8]) as in the current study was observed in a recent multicenter study from Austria [7], whereas in a Canadian multicenter study that observed narrowly identical mortality rates lower differences (T3-4 in females 61 vs. 58% in males [6]) were found. In one multicenter study, a lower 90-day mortality rate was observed in females [9], a finding that was not confirmed in our study (Table 1).…”

“…The 21.8% rate of administration of adjuvant cisplatinbased chemotherapy in the current study was narrowly identical with the rates observed in multicenter studies [3,6]. This rate contrasts with 48.9% high risk patients with either extravesical or lymph node-positive disease who could be candidates for such treatment (Table 1).…”

“…p values are given for the Pepe Mori test. Whereas in 2 multicenter studies which started patient recruitment in 1971 [3] and 1979 [10] higher bladder cancer-specific mortality after radical cystectomy was observed in females, a multicenter study enrolling patients between 1994 and 2008 did not find measurable gender-related mortality differences [6]. Several possible explanations have been discussed for the overweight of more advanced tumor stages and for the adverse outcome in females with bladder cancer [1].…”

“…The reasons for this phenomenon are discussed controversially [1]. Other authors, however, did not observe gender-related outcome differences [4][5][6]. We investigated a large single center sample with longterm follow-up in order to identify gender-related differences in prognostic parameters and in the mortality risk from bladder cancer and from competing causes.…”

Is there a measurable association of epidural use at cystectomy and postoperative outcomes? A population-based study

“…The finding that TEA use was less frequent in women is of interest and potentially highlights perceived inequities in management and outcomes of women with bladder cancer. 28 Despite its recognized importance in early outcomes in related surgical populations, 8,9 there is a paucity of evidence supporting TEA-associated improvement of patient outcomes in RC. Evidence often quoted supporting use of TEA in reduction of short-term complications in RC come from the ERAS literature.…”