Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Urology. 2021 May;151:169-175. doi: 10.1016/j.urology.2020.06.058. Epub 2020 Jul 14.
To investigate the association of female sex with the selected treatment for patients with nonmetastatic muscle-invasive bladder cancer. Sex is a known independent predictor of death from bladder cancer. A potential explanation for this survival disparity is difference in treatment pattern and stage presentation among males and females.
Using the surveillance, epidemiology, and end results-medicare data set, we identified 6809 patients initially diagnosed with nonmetastatic muscle-invasive bladder cancer between 2004 and 2014. We fit multivariable logistic regression and Cox models to assess the relationship of sex with treatment modality and survival adjusting for differences in patient characteristics.
Of the 6809 patients with nonmetastatic muscle invasive bladder cancer, 2528 (37%) received a radical cystectomy while 4281 (63%) received an alternative bladder sparing intervention. Women were significantly more likely to receive a cystectomy (odds ratios [OR] 1.39; 95% confidence intervals [CI] 1.20-1.61), present at an older age with less comorbidities compared to men (P <.001). Women were also found to have worse bladder cancer-specific survival (CSS) than men (hazard ratio [HR] 1.18; 95% CI 1.05-1.32), no difference in overall survival (OS) (female HR 0.93; 0.86-1.01) and lower mortality from other causes (HR 0.78; 95% CI 0.70-0.86). There were no differences in OS and CSS by sex in patients with stage pT4a.
Female sex predicted more aggressive treatment with radical cystectomy yet worse cancer-specific survival than males. This sex disparity in CSS reduced the known OS advantage observed in women.
研究女性性别与非转移性肌层浸润性膀胱癌患者所选治疗方法之间的关联。性别是膀胱癌死亡的已知独立预测因素。这种生存差异的一个潜在解释是男性和女性之间的治疗模式和分期表现存在差异。
我们使用监测、流行病学和最终结果-医疗保险数据集，确定了 2004 年至 2014 年间 6809 例最初诊断为非转移性肌层浸润性膀胱癌的患者。我们通过多变量逻辑回归和 Cox 模型评估了性别与治疗方式和生存之间的关系，调整了患者特征的差异。
在 6809 例非转移性肌层浸润性膀胱癌患者中，2528 例（37%）接受根治性膀胱切除术，4281 例（63%）接受替代膀胱保留干预。与男性相比，女性接受膀胱切除术的可能性显著更高（比值比 [OR] 1.39；95%置信区间 [CI] 1.20-1.61），且年龄较大，合并症较少（P<0.001）。与男性相比，女性的膀胱癌特异性生存率（CSS）也较差（风险比 [HR] 1.18；95%CI 1.05-1.32），总生存率（OS）无差异（女性 HR 0.93；95%CI 0.86-1.01），其他原因死亡率较低（HR 0.78；95%CI 0.70-0.86）。在 pT4a 期患者中，性别对 OS 和 CSS 无影响。
女性性别预测更激进的治疗方法，即根治性膀胱切除术，但比男性的癌症特异性生存率更差。这种 CSS 性别差异降低了女性观察到的已知 OS 优势。
