Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Clin Genitourin Cancer. 2021 Apr;19(2):135-143. doi: 10.1016/j.clgc.2020.12.001. Epub 2021 Jan 6.
To test the effect of sex on histologic subtype, stage at presentation, treatment, and cancer-specific mortality (CSM) in urethral cancer.
We identified urethral cancer patients within the Surveillance, Epidemiology, and End Results (SEER) registry (2004-2016). After matching for tumor and patient characteristics, cumulative incidence plots and multivariable competing risks regression models, adjusted for other-cause mortality, tested CSM according to sex.
Of 1645 eligible urethral cancer patients, 1073 (65%) were male. Urothelial histologic subtype was most frequent in male (59%) but not female (27%) subjects. Adenocarcinoma, squamous cell carcinoma, and other histologies were more frequent in female patients. Most male subjects harbored T1N0M0 (32%) stage disease, whereas most female subjects harbored T3-4N0M0 (29%) stage disease. In urothelial and adenocarcinoma histologic subtypes, African American female subjects were most prevalent (31 and 78%) versus whites (16 and 52%) versus Hispanics (27 and 74%). In T1N0M0 stage, single-mode surgical treatment was more frequent in male than female patients (respectively, 73% vs 59%). In T3-4 and/or N1-2 stage disease, multimodal therapy was more frequent in female than male (42% vs 37%) patients. In nonmetastatic urethral cancer (T1-4N0-2M0), after propensity score matching for stage, race, treatment, and age, cumulative incidence plots showed 5-year CSM of 36% and 25% in female and male patients, respectively, and after further multivariable adjustment resulted in 1.3-fold higher CSM in female as opposed to male patients (P = .07).
Female patients with urethral cancer present with higher disease stage. Despite higher rates of multimodal therapy, and despite matching for stage disadvantage, female subjects with urethral cancer exhibited higher CSM.
检测性别的影响在尿道癌的组织学亚型、发病时的分期、治疗和癌症特异性死亡率（CSM）中的作用。
我们在监测、流行病学和最终结果（SEER）登记处（2004-2016 年）中确定了尿道癌患者。在对肿瘤和患者特征进行匹配后，通过累积发生率图和多变量竞争风险回归模型，在考虑其他原因死亡率的情况下，根据性别检测 CSM。
在 1645 名符合条件的尿道癌患者中，有 1073 名（65%）为男性。在男性（59%）而非女性（27%）患者中，尿路上皮组织学亚型最为常见。腺癌、鳞状细胞癌和其他组织学类型在女性患者中更为常见。大多数男性患者患有 T1N0M0（32%）期疾病，而大多数女性患者患有 T3-4N0M0（29%）期疾病。在尿路上皮和腺癌组织学亚型中，非洲裔美国女性患者最为常见（31%和 78%），而白人患者（16%和 52%）和西班牙裔患者（27%和 74%）。在 T1N0M0 期，单一模式手术治疗在男性患者中比女性患者更为常见（分别为 73%和 59%）。在 T3-4 和/或 N1-2 期疾病中，女性患者的多模式治疗比男性患者更为常见（分别为 42%和 37%）。在非转移性尿道癌（T1-4N0-2M0）中，在对分期、种族、治疗和年龄进行倾向评分匹配后，女性和男性患者的 5 年 CSM 分别为 36%和 25%，进一步多变量调整后，女性患者的 CSM 比男性患者高 1.3 倍（P=0.07）。
患有尿道癌的女性患者呈现更高的疾病分期。尽管女性患者多模式治疗的比例较高，并且尽管分期不利因素进行了匹配，但患有尿道癌的女性患者的 CSM 仍然较高。
