Otto Wolfgang, May Matthias, Fritsche Hans-Martin, Dragun Duska, Aziz Atiqullah, Gierth Michael, Trojan Lutz, Herrmann Edwin, Moritz Rudolf, Ellinger Jörg, Tilki Derya, Buchner Alexander, Höfner Thomas, Brookman-May Sabine, Nuhn Philipp, Gilfrich Christian, Roigas Jan, Zacharias Mario, Denzinger Stefan, Hohenfellner Markus, Haferkamp Axel, Müller Stefan C, Kocot Arkadius, Riedmiller Hubertus, Wieland Wolf F, Stief Christian G, Bastian Patrick J, Burger Maximilian
Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Landshuterstrasse 65, Regensburg, Germany.
Gend Med. 2012 Dec;9(6):481-9. doi: 10.1016/j.genm.2012.11.001.
Outcome of patients with urothelial carcinoma of the bladder (UCB) varies between sexes. Although overall incidence is higher in men, cancer-specific survival (CSS) has been suggested to be lower in women. Although the former effect is attributed to greater exposure to carcinogens in men, the latter has not been elucidated.
The aim of the study was to identify sex-specific outcomes based on one of the largest databases of patients with UCB who underwent radical cystectomy (RC).
This retrospective multicenter series comprised 2483 patients in Stage M0 who underwent RC for UCB from 1989 to 2008; 20.4% of patients were women. The impact of sex on CSS in the entire study group and in specific subgroups was analyzed. The median follow-up time was 42 months (interquartile range, 21-79).
Histopathologic criteria of pathologic tumor (pT), pathologic nodal (pN), grade, lymphovascular invasion (LVI), and associated carcinoma in situ (CIS) of the study did not differ between sexes. The percentage of female patients increased over time. Five-year CSS in female patients was significantly lower than in male patients (60% vs 66%; P = 0.005). In multivariate analysis adjusted to other covariates, tumor stage ≥pT3 (hazard ratio [HR] = 2.44; P < 0.001), positive pN status (HR = 1.91; P < 0.001), LVI (HR = 1.48; P < 0.001), lower count of lymph nodes removed (HR = 0.98; P = 0.002), older age (HR = 1.01; P < 0.001), and female gender (HR = 1.26; P = 0.011) had an independent impact on CSS. Deterioration of CSS in female patients was pronounced when LVI was present (HR = 1.57; P < 0.001) and when RC was performed in the earlier time period (HR = 2.44; P < 0.001). However, women showed significantly lower perioperative mortality (within 90 days after RC) compared with men.
After RC for UCB, cancer-specific mortality was higher in female patients; this disadvantage was more pronounced in earlier time periods. In addition, worse outcome of women with verified LVI was shown to be comparable with men. These findings were suggestive of different tumor biology and potentially unequal access to timely RC in earlier time periods because of reduced awareness of UCB in women. Further studies are required to improve UCB outcome in both sexes, notably in female patients.
膀胱尿路上皮癌（UCB）患者的预后存在性别差异。尽管总体发病率男性更高，但有研究表明女性的癌症特异性生存率（CSS）更低。虽然前者的影响归因于男性接触致癌物的机会更多，但后者的原因尚未阐明。
本研究旨在基于接受根治性膀胱切除术（RC）的UCB患者最大数据库之一，确定性别特异性的预后情况。
这项回顾性多中心研究纳入了1989年至2008年期间因UCB接受RC的2483例M0期患者；其中20.4%为女性。分析了性别对整个研究组及特定亚组CSS的影响。中位随访时间为42个月（四分位间距为21 - 79个月）。
本研究中病理肿瘤（pT）、病理淋巴结（pN）、分级、淋巴管侵犯（LVI）及相关原位癌（CIS）的组织病理学标准在性别间无差异。女性患者的比例随时间增加。女性患者的5年CSS显著低于男性患者（60%对66%；P = 0.005）。在对其他协变量进行校正的多因素分析中，肿瘤分期≥pT3（风险比[HR] = 2.44；P < 0.001）、pN阳性状态（HR = 1.91；P < 0.001）、LVI（HR = 1.48；P < 0.001）、切除淋巴结数量较少（HR = 0.98；P = 0.002）、年龄较大（HR = 1.01；P < 0.001）及女性性别（HR = 1.26；P = 0.011）对CSS有独立影响。当存在LVI时（HR = 1.57；P < 0.001）以及在较早时间段进行RC时（HR = 2.44；P < 0.001），女性患者CSS的恶化更为明显。然而，与男性相比，女性患者围手术期死亡率（RC后90天内）显著更低。
UCB患者接受RC后，女性患者的癌症特异性死亡率更高；这种劣势在较早时间段更为明显。此外，证实存在LVI的女性患者较差的预后与男性相当。这些发现提示了不同的肿瘤生物学特性，并且可能由于女性对UCB的认知度较低，在较早时间段获得及时RC的机会不平等。需要进一步研究以改善男女两性UCB的预后，尤其是女性患者。
