Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
Urol Oncol. 2020 Jul;38(7):639.e1-639.e9. doi: 10.1016/j.urolonc.2020.01.010. Epub 2020 Feb 11.
To assess the effect of patient's sex on response to neoadjuvant chemotherapy (NAC) in patients with clinically nonmetastatic muscle-invasive bladder cancer (MIBC).
Complete pathologic response, defined as ypT0N0 at radical cystectomy, and downstaging were evaluated using sex-adjusted univariable and multivariable logistic regression modeling. We used interaction terms to account for age of menopause and smoking status. The association of sex with overall survival and cancer-specific survival was evaluated using Cox regression analyses.
A total of 1,031 patients were included in the analysis, 227 (22%) of whom were female. Female patients had a higher rate of extravesical disease extension (P = 0.01). After the administration of NAC, ypT stage was equally distributed between sexes (P = 0.39). On multivariable logistic regression analyses, there was no difference between the sexes or age of menopause with regards to ypT0N0 rates or downstaging (all P > 0.5). On Cox regression analyses, sex was associated with neither overall survival (hazard ratio 1.04, 95% confidence interval 0.75-1.45, P = 0.81) nor cancer-specific survival (hazard ratio 1.06, 95% confidence interval 0.71-1.58, P = 0.77).
Our study generates the hypothesis that NAC equalizes the preoperative disparity in pathologic stage between males and females suggesting a possible differential response between sexes. This might be the explanation underlying the comparable survival outcomes between sexes despite females presenting with more advanced tumor stage.
评估患者性别对接受新辅助化疗（NAC）的临床非转移性肌层浸润性膀胱癌（MIBC）患者的反应的影响。
使用性别调整的单变量和多变量逻辑回归模型评估完全病理缓解（定义为根治性膀胱切除术后的 ypT0N0）和降期。我们使用交互项来考虑绝经年龄和吸烟状态。使用 Cox 回归分析评估性别与总生存和癌症特异性生存的相关性。
共纳入 1031 例患者，其中 227 例（22%）为女性。女性患者有更高的膀胱外疾病扩展率（P=0.01）。在接受 NAC 治疗后，ypT 分期在性别之间分布均匀（P=0.39）。在多变量逻辑回归分析中，性别或绝经年龄与 ypT0N0 率或降期之间没有差异（均 P>0.5）。在 Cox 回归分析中，性别与总生存（危险比 1.04，95%置信区间 0.75-1.45，P=0.81）或癌症特异性生存（危险比 1.06，95%置信区间 0.71-1.58，P=0.77）均无相关性。
我们的研究提出了一个假设，即 NAC 使男性和女性之间术前病理分期的差异均等化，表明性别之间可能存在不同的反应。这可能是尽管女性肿瘤分期更晚，但性别之间生存结果相当的解释。
