Venkat Siv, Khan Aleem I, Taylor Benjamin L, Patel Neal A, Al Hussein Al Awamlh Bashir, Calderon Lina Posada, Fainberg Jonathan, Shoag Jonathan, Scherr Douglas S
Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY.
Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY.
Urol Oncol. 2022 Mar;40(3):106.e21-106.e29. doi: 10.1016/j.urolonc.2021.09.003. Epub 2021 Oct 7.
Sex-specific survival disparities for bladder cancer outcomes after radical cystectomy (RC) have been demonstrated in several studies. However, these studies predate the widespread adoption of neoadjuvant chemotherapy (NAC). We evaluated the differences in sex-specific survival between patients who received NAC with those who did not, using a contemporary national outcomes database.
The National Cancer Data Base was queried from 2004 to 2015 to identify subjects who underwent RC. Kaplan-Meier method with log-rank test was performed to compare all-cause mortality between men and women at each pathologic (p) TNM stage group: T1-4N0, N+ and M+ disease. Associations for all-cause mortality were identified using an adjusted Cox regression analysis, and our findings were confirmed with a subgroup analysis.
A total of 9,835 subjects (7,483 men and 2,532 women) were included in the analysis. Kaplan-Meier survival curves and Cox regression analysis demonstrated female sex was not associated with worse overall survival compared to males (HR 0.947, 95%CI 0.852-1.053, P = 0.947) in the overall cohort. Stratified by pT stage and node positivity, worse overall survival was seen in women with pT4 disease who did not receive NAC compared to men (5-year OS 9.6% women vs. 15.2% men, P < 0.001), but no sex-specific difference was seen across all groups in patients who received NAC. Subgroup multivariable analysis showed that female sex conferred a survival disadvantage for pT4 (HR 1.369, P = 0.026) disease only in patients who did not receive NAC.
In a contemporary cohort of subjects who underwent RC, administration of NAC narrows the sex survival-gap in advanced stage bladder cancer. Strategies to improve NAC usage in women should be adopted to overcome potential sex-specific differences such as delayed diagnosis, anatomic differences in higher stage disease, or altered tumor biology which may contribute to differences in oncologic outcomes.
多项研究表明，根治性膀胱切除术（RC）后膀胱癌患者的生存差异存在性别特异性。然而，这些研究早于新辅助化疗（NAC）的广泛应用。我们使用当代全国性结局数据库，评估了接受NAC与未接受NAC的患者在性别特异性生存方面的差异。
查询2004年至2015年的国家癌症数据库，以确定接受RC的受试者。采用Kaplan-Meier法和对数秩检验，比较各病理（p）TNM分期组（T1-4N0、N+和M+疾病）男性和女性的全因死亡率。使用校正后的Cox回归分析确定全因死亡率的相关性，并通过亚组分析证实我们的发现。
共有9835名受试者（7483名男性和2532名女性）纳入分析。Kaplan-Meier生存曲线和Cox回归分析表明，在整个队列中，与男性相比，女性性别与较差的总生存率无关（HR 0.947，95%CI 0.852-1.053，P = 0.947）。按pT分期和淋巴结阳性分层，未接受NAC的pT4期女性患者的总生存率低于男性（5年总生存率：女性为9.6%，男性为15.2%，P < 0.001），但在接受NAC的患者中，所有组均未发现性别特异性差异。亚组多变量分析显示，仅在未接受NAC的患者中，女性性别对pT4期疾病（HR 1.369，P = 0.026）具有生存劣势。
在当代接受RC的受试者队列中，NAC的使用缩小了晚期膀胱癌的性别生存差距。应采取策略提高女性对NAC的使用，以克服潜在的性别特异性差异，如诊断延迟、晚期疾病的解剖学差异或肿瘤生物学改变，这些差异可能导致肿瘤学结局的差异。
