Bilski Konrad, Zapała Łukasz, Skrzypczyk Michał A, Oszczudłowski Maciej, Dobruch Jakub
Department of Urology, Centre of Postgraduate Medical Education, Independent Public Hospital of Professor W. Orlowski, Warsaw, Poland.
Transl Androl Urol. 2019 Feb;8(1):12-20. doi: 10.21037/tau.2018.11.06.
Differences in the epidemiology, diagnosis and outcomes according to gender in patients diagnosed with non-muscle invasive bladder cancer (NMIBC) has been widely reported. In this article we present gender-specific differences in NMIBC in terms of epidemiology, risk factors, first clinical presentation, management and clinical outcomes based on systematically review evidence of existing literature. A literature search of English-language publications that included an analysis of the association of gender differences in patients with NMIBC was performed using PubMed. Sixty-four studies were selected for analysis with consensus of all authors. The incidence and mortality for urothelial bladder cancer (UBC) are higher in men, whereas cancer specific mortality to incidence ratio is significantly lower for men than for women. This phenomenon could be partially explained by differences in exposure to bladder cancer carcinogens. However female gender is associated with higher stage at presentation. Thirteen studies with a total of 11,069 patients diagnosed with NMIBC were included for analysis according to outcomes. In studies that found statistically significant differences in outcomes between sexes, female gender was reported as risk factor for disease recurrence, progression or cancer specific mortality. None of included studies found worse outcomes in men when compared to women with NMIBC. Results of our review suggest that female gender in patients diagnosed with NMIBC is associated-though inconsistently-with higher stage at presentation and poorer outcomes. Numerous factors may influence gender gap in incidence rate, clinical management and reported outcomes. Consensus on comparable data collection in routine practice and prospective trials including clinical outcomes are required to identify gender-specific differences in patients diagnosed with NMIBC.
非肌层浸润性膀胱癌（NMIBC）患者中，根据性别在流行病学、诊断及预后方面的差异已有广泛报道。在本文中，我们基于对现有文献证据的系统回顾，呈现NMIBC在流行病学、危险因素、首次临床表现、治疗及临床预后方面的性别特异性差异。使用PubMed对英文出版物进行文献检索，纳入分析NMIBC患者性别差异相关性的研究。经所有作者一致同意，选取64项研究进行分析。尿路上皮癌（UBC）的发病率和死亡率男性更高，而男性的癌症特异性死亡率与发病率之比显著低于女性。这种现象部分可由膀胱癌致癌物暴露差异来解释。然而，女性在初诊时肿瘤分期较高。根据预后情况，纳入13项研究，共11069例诊断为NMIBC的患者进行分析。在发现性别间预后存在统计学显著差异的研究中，女性被报道为疾病复发、进展或癌症特异性死亡的危险因素。纳入研究中，没有一项发现NMIBC男性患者的预后比女性更差。我们的综述结果表明，诊断为NMIBC的女性患者，尽管结果不一致，但与初诊时较高分期及较差预后相关。许多因素可能影响发病率、临床治疗及报道的预后方面的性别差异。需要在常规实践和前瞻性试验中就可比数据收集达成共识，包括临床预后，以确定诊断为NMIBC患者的性别特异性差异。
