Choo Min Soo, Jeong Chang Wook, Kwak Cheol, Kim Hyeon Hoe, Ku Ja Hyeon
Department of Urology, Dongtan Sacred Heart Hospital, Hwaseong, Korea.
Department of Urology, Seoul National University Hospital, Seoul, Korea.
Clin Genitourin Cancer. 2015 Apr;13(2):e113-21. doi: 10.1016/j.clgc.2014.09.006. Epub 2014 Nov 4.
The aim of the present study was to evaluate the effect of differences between the sexes on the prognosis of urothelial carcinoma after adjusting for other factors by using propensity score matching.
Between 2000 and 2011, 678 consecutive patients who had undergone radical cystectomy or radical nephroureterectomy for urothelial carcinoma were enrolled in this study. Propensity score methodology was used to adjust for selection bias with 10 and 12 perioperative variables for urothelial carcinoma of the bladder (UCB) and upper tract urothelial carcinoma (UTUC). By a 2:1 male-to-female patient matching ratio, we selected 38 and 66 pairs of patients with UCB and UTUC.
The number of male patients was 573 (84.5%), and there were 105 female patients (15.5%). The mean follow-up was 55.5 ± 38.4 months. There were no significant differences in the perioperative variables of age, pathologic T (pT) stage, grade, lymphovascular invasion (LVI), and concomitant carcinoma in situ (CIS) between the sexes. Neither cancer-specific survival (CSS) or overall survival (OS) was associated with sex in a multivariate Cox proportional hazard model. In propensity score matching analysis, female sex was not an independent risk factor for CSS and OS in urothelial carcinoma. In patients with UCB, body mass index (BMI) and pT stage were independently associated with CCS. For the patients with UTUC, age, pT stage, LVI, adjuvant chemotherapy, bladder cuffing, and location were significantly correlated.
After adjusting for other risk factors with propensity score matching, female sex may not be an independent risk factor in prognosis for urothelial carcinoma (UC).
本研究的目的是通过倾向评分匹配来评估在调整其他因素后性别差异对尿路上皮癌预后的影响。
2000年至2011年期间，本研究纳入了678例因尿路上皮癌接受根治性膀胱切除术或根治性肾输尿管切除术的连续患者。采用倾向评分方法，针对膀胱尿路上皮癌（UCB）和上尿路尿路上皮癌（UTUC），分别用10个和12个围手术期变量来调整选择偏倚。按照男性与女性患者2:1的匹配比例，我们分别为UCB和UTUC选择了38对和66对患者。
男性患者有573例（84.5%），女性患者有105例（15.5%）。平均随访时间为55.5±38.4个月。性别之间在年龄、病理T（pT）分期、分级、淋巴管浸润（LVI）和伴发原位癌（CIS）的围手术期变量方面无显著差异。在多变量Cox比例风险模型中，癌症特异性生存（CSS）或总生存（OS）均与性别无关。在倾向评分匹配分析中，女性并非尿路上皮癌CSS和OS的独立危险因素。对于UCB患者，体重指数（BMI）和pT分期与CCS独立相关。对于UTUC患者，年龄、pT分期、LVI、辅助化疗、膀胱袖套状切除和部位显著相关。
通过倾向评分匹配调整其他危险因素后，女性可能并非尿路上皮癌（UC）预后的独立危险因素。
