Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Preventative Medicine, Keck School of Medicine, University of Southern CA, Los Angeles, CA, USA.
Cancer Med. 2021 May;10(9):3004-3012. doi: 10.1002/cam4.3835. Epub 2021 Mar 28.
In surgical series of muscle-invasive bladder cancer (MIBC), women have higher recurrence rates, disease progression, and mortality following radical cystectomy than men. Similar reports of oncologic differences between men and women following trimodality therapy (TMT) are rare. Our hypothesis was that there would be no difference in overall survival (OS) between sexes receiving TMT.
We queried the National Cancer Database (NCDB) for patients diagnosed with clinical stage T2-T4aN0 M0 MIBC between 2004-2016. We considered patients to have received TMT if they received 55 Gy in 20 fractions or 59.4-70.2 Gy of radiotherapy with concurrent chemotherapy following a transurethral resection of bladder tumor (TURBT). We used multivariable Cox proportional hazard models to determine whether sex was associated with risk of mortality. In addition to OS, we calculated relative survival (RS) to adjust for the fact that females generally survive longer than males.
Of the patients, 1960 underwent TMT and had survival data. Less than one quarter were female. In the first year following treatment, women had worse OS and RS than men (p = 0.093 and p = 0.030, respectively). However, overall and relative survival differences between sexes were not statistically significantly different in Years 2 and later. Unlike with OS, the RS between sexes remained significant at 9 years; in multivariable analysis based on RS, women were 43% more likely to die than men (p < 0.001).
Women had a higher initial risk of death than men in the first year following TMT. However, long-term survival between sexes was similar. TMT is an important treatment option in both men and women seeking bladder preservation.
在接受根治性膀胱切除术的肌层浸润性膀胱癌（MIBC）手术系列中，女性的复发率、疾病进展和死亡率均高于男性。关于男女接受三联疗法（TMT）后肿瘤学差异的类似报告很少。我们的假设是，接受 TMT 的男性和女性之间的总生存率（OS）没有差异。
我们从国家癌症数据库（NCDB）中查询了 2004-2016 年间诊断为临床分期 T2-T4aN0 M0 MIBC 的患者。如果患者接受了 55 Gy 共 20 次分割或 59.4-70.2 Gy 放疗，同时接受顺铂化疗，我们认为他们接受了 TMT，并且在 TURBT 后进行了治疗。我们使用多变量 Cox 比例风险模型来确定性别是否与死亡率相关。除了 OS 之外，我们还计算了相对生存率（RS），以调整女性一般比男性寿命长的事实。
在接受 TMT 治疗并具有生存数据的 1960 名患者中，不到四分之一是女性。在治疗后的第一年，女性的 OS 和 RS 比男性差（p=0.093 和 p=0.030）。然而，在第 2 年及以后，男女之间的总体和相对生存率差异没有统计学意义。与 OS 不同，性别之间的 RS 在 9 年后仍然显著；在基于 RS 的多变量分析中，女性死亡的可能性比男性高 43%（p<0.001）。
在接受 TMT 治疗后的第一年，女性的死亡风险高于男性。然而，男女之间的长期生存情况相似。TMT 是寻求膀胱保留的男性和女性的重要治疗选择。
