School of Medicine.
Department of Urology, University of California, San Francisco, California, USA.
Curr Opin Urol. 2019 Sep;29(5):542-547. doi: 10.1097/MOU.0000000000000660.
The purpose of this article is to review and summarize recent data on gender differences in oncologic and functional outcomes in women undergoing radical cystectomy with urinary diversion as contemporary studies have highlighted a potential disparity in outcomes between men and women.
Gender (being a woman) as a social determinant of health negatively affects oncologic outcome in women with bladder cancer treated with radical cystectomy secondary to delays in diagnosis, treatment, and misdiagnosis. Sex (being female) negatively affects oncologic outcome in women with bladder cancer treated with radical cystectomy through tumor and host biology. Female patients present with advance stage and basal molecular subtype tumors enriched with squamous and sarcomatoid histology. Preliminary studies implicate the hormonal axis in differential bladder cancer development and progression between women and men. After radical cystectomy, functional outcomes (urinary, sexual, and overall quality of life) are poorly assessed in women yet important for both physicians and patients for clinical decision-making and counseling.
Future research (clinical trials, assessment of functional outcomes using gender-specific measures) must include women with bladder cancer and raise awareness regarding the gaps in knowledge and care for these patients.
本文旨在回顾和总结近期关于女性接受根治性膀胱切除术伴尿流改道的肿瘤学和功能结局的性别差异的研究数据，因为目前的研究强调了男性和女性之间可能存在结局差异。
性别（女性）作为健康的社会决定因素，通过诊断、治疗和误诊的延迟，对接受根治性膀胱切除术治疗的膀胱癌女性的肿瘤学结局产生负面影响。性别（女性）通过肿瘤和宿主生物学对接受根治性膀胱切除术治疗的膀胱癌女性的肿瘤学结局产生负面影响。女性患者表现为晚期和基底分子亚型肿瘤，富含鳞状和肉瘤样组织学。初步研究表明，激素轴在女性和男性之间的膀胱癌发展和进展中存在差异。根治性膀胱切除术后，女性的功能结局（尿、性和整体生活质量）评估不佳，但对医生和患者而言，这些结局对临床决策和咨询都很重要。
未来的研究（临床试验、使用性别特异性措施评估功能结局）必须纳入膀胱癌女性，并提高对这些患者知识和护理差距的认识。
