Department of Urology, University Medical Center Goettingen, Goettingen, Germany.
Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.
J Urol. 2018 Jul;200(1):48-60. doi: 10.1016/j.juro.2017.11.150. Epub 2018 Mar 1.
We summarize the evidence on gender specific differences in disease-free, cancer specific and overall survival after radical cystectomy for bladder cancer.
We performed a systematic literature search of MEDLINE®, Embase® and the Cochrane Library in July 2017. Studies evaluating gender specific differences in disease-free, cancer specific or overall survival after radical cystectomy for bladder cancer were included in study. Analyses included random effect meta-analysis, subgroup analyses, meta-influence and cumulative meta-analyses. Funnel plots and the Egger test were used to assess publication bias.
Of the 3,868 studies identified during the literature search 59 published between 1998 and 2017 were included in analysis. Of the studies 30 in a total of 38,321 patients evaluated disease-free survival, 44 in a total of 69,666 evaluated cancer specific survival and 26 in a total of 30,039 evaluated overall survival. Random effect meta-analyses revealed decreased disease-free, cancer specific survival and overall survival in female patients than in their male counterparts. Pooled estimates showed a HR of 1.16 (95% CI 1.06-1.27, p = 0.0018) for disease-free survival, 1.23 (95% CI 1.15-1.31, p <0.001) for cancer specific survival and 1.08 (95% CI 1.03-1.12, p = 0.0004) for overall survival. Subgroup analyses confirmed impaired disease-free, cancer specific and overall survival in female patients in all strata. Publication bias was evident only for studies of cancer specific survival (Egger test p = 0.0029). After adjusting for publication bias by the trim and fill method the corrected pooled estimated HR of cancer specific survival was 1.13 (95% CI 1.05-1.21, p = 0.0012).
Female patients who underwent radical cystectomy for bladder cancer demonstrated worse disease-free, cancer specific and overall survival than their male counterparts. The multifactorial etiology might include epidemiological differences, gender specific health care discrepancies and hormonal influences.
我们总结了根治性膀胱切除术治疗膀胱癌后无病生存率、癌症特异性生存率和总体生存率的性别差异证据。
我们于 2017 年 7 月对 MEDLINE®、Embase®和 Cochrane 图书馆进行了系统的文献检索。纳入评估根治性膀胱切除术治疗膀胱癌后无病生存率、癌症特异性生存率或总体生存率的性别差异的研究。分析包括随机效应荟萃分析、亚组分析、荟萃影响分析和累积荟萃分析。使用漏斗图和 Egger 检验评估发表偏倚。
在文献检索中，共确定了 3868 项研究，其中 59 项发表于 1998 年至 2017 年期间，纳入分析。在这些研究中，30 项研究共 38321 例患者评估了无病生存率，44 项研究共 69666 例患者评估了癌症特异性生存率，26 项研究共 30039 例患者评估了总体生存率。随机效应荟萃分析显示，女性患者的无病生存率、癌症特异性生存率和总体生存率低于男性患者。汇总估计显示，无病生存率的 HR 为 1.16（95%CI 1.06-1.27，p = 0.0018），癌症特异性生存率的 HR 为 1.23（95%CI 1.15-1.31，p<0.001），总体生存率的 HR 为 1.08（95%CI 1.03-1.12，p = 0.0004）。亚组分析证实，女性患者在所有亚组中均存在无病生存率、癌症特异性生存率和总体生存率受损。仅癌症特异性生存率的研究存在发表偏倚（Egger 检验 p = 0.0029）。通过修剪和填充法校正发表偏倚后，癌症特异性生存率的校正汇总估计 HR 为 1.13（95%CI 1.05-1.21，p = 0.0012）。
接受根治性膀胱切除术治疗膀胱癌的女性患者无病生存率、癌症特异性生存率和总体生存率均较男性患者差。多因素病因可能包括流行病学差异、性别特异性医疗保健差异和激素影响。
