State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong, People's Republic of China.
Med Oncol. 2013;30(3):640. doi: 10.1007/s12032-013-0640-6. Epub 2013 Jun 19.
The research is to evaluate the age-specific differential effects of gender on outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Between August 1998 and October 2010, we retrospectively reviewed the data from 285 (67.7%) men and 136 (32.3%) women treated with RNU for UTUC at our two institutions. Kaplan-Meier survival estimates the age-specific effect of gender on cancer-specific survival (CSS). Cox proportional hazards regression analyses were used to address the effect of gender on CSS. No significant sex-related differences were found in age and diagnosis, clinicopathologic features, and treatment (all P values >0.05). Women had a 18.7% increased risk of death from UTUC than men (hazard ratio [HR] 1.187; 95% confidence interval [95% CI] 1.017-1.893; P = 0.021). The survival disadvantage was only present in patients aged 59 years and older (P < 0.001). Conversely, the survival advantage for women was found in women aged 42 to 58 years (P = 0.011) and in the age group <42 years (P = 0.019). On multivariable Cox regression analyses that adjusted for the effects of clinicopathologic features, the female gender was associated with decreased CSS (P = 0.036). In conclusion, the impact of gender on UTUC outcomes after RNU is age-specific. Females who aged 59 years and older experienced worse outcomes than their male counterparts, while women in the age group <42 years and 42-58 years have better outcomes than men. Further research is needed to elucidate the molecular mechanisms underlying the age-specific differential effect of gender on UTUC outcomes.
本研究旨在评估性别对上尿路尿路上皮癌（UTUC）患者接受根治性肾输尿管切除术（RNU）治疗后结局的年龄特异性差异影响。1998 年 8 月至 2010 年 10 月，我们回顾性分析了在我们两个机构接受 RNU 治疗的 285 例（67.7%）男性和 136 例（32.3%）女性的 UTUC 数据。Kaplan-Meier 生存估计年龄特异性性别对癌症特异性生存（CSS）的影响。Cox 比例风险回归分析用于评估性别对 CSS 的影响。年龄和诊断、临床病理特征以及治疗方面均未发现明显的性别差异（所有 P 值>0.05）。女性死于 UTUC 的风险比男性高 18.7%（风险比 [HR] 1.187；95%置信区间 [95%CI] 1.017-1.893；P = 0.021）。这种生存劣势仅存在于 59 岁及以上的患者中（P<0.001）。相反，在 42 至 58 岁的女性（P = 0.011）和<42 岁的女性（P = 0.019）中发现了女性的生存优势。在调整了临床病理特征影响的多变量 Cox 回归分析中，女性性别与 CSS 降低相关（P = 0.036）。总之，性别对 RNU 后 UTUC 结局的影响是年龄特异性的。59 岁及以上的女性比男性的结局更差，而<42 岁和 42-58 岁的女性比男性的结局更好。需要进一步研究阐明性别对 UTUC 结局的年龄特异性差异影响的分子机制。
