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

Abstract

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.

Impact of gender on tumor stage and survival of upper urinary tract urothelial cancer

“…Furthermore, many series are hampered by the limited sample size due to the low incidence of UTUC; however, the two largest, population-based studies in this respect support this gender-specific stage shift in UTUC. Our group has recently reported a similar phenomenon by analysing 27,733 patients with bladder cancer in Austria [15]. It has been postulated that a gender-specific referral pattern might be a major factor for the stage shift in women with bladder cancer [16] and one can speculate that the same also applies for UTUC.…”

“…We have adjusted the effect of age in a descriptive and a statistical-inferential way. The statistical analyses, however, were hampered by the relatively low number of events particularly per stage group, when comparing the results, e. g. to a similar analysis of our group of bladder cancer patients using a 10-fold larger data base [15]. …”

The Impact of Gender on Tumour Stage in In-House Complications and Choice of Urinary Diversion: Results of the Austrian Cystectomy Registry

“…Another survey of over 20,000 patients from the Netherlands Cancer registry reported a higher rate of advanced tumour stages in women [5]. In a nationwide Austrian study on bladder cancer, Waldhoer et al [13] have demonstrated that the men-to-female ratio declined constantly from 3: 1 for pT1 tumours to 1.9: 1 in those with pT4 tumours. It remains controversial whether women have a worse prognosis when treated, for example, by RC if the stage-shift at diagnosis is taken into account [14][15][16].…”

Closing the Gender Gap: Can We Improve Bladder Cancer Survival in Women? - A Systematic Review of Diagnosis, Treatment and Outcomes

“…Most large studies refute this, however, with evidence that women not only present with more advanced tumors than their male counterparts [8,21,22,23,24,25,26], but are also more likely to have nodal involvement at diagnosis [8,23,27]. …”