Kaczmarek Krystian, Lemiński Artur, Małkiewicz Bartosz, Gurwin Adam, Lisiński Janusz, Słojewski Marcin
Department of Urology and Urological Oncology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland.
Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland.
J Clin Med. 2023 Feb 5;12(4):1260. doi: 10.3390/jcm12041260.
There is a well-documented problem of inferior outcome of muscle-invasive bladder cancer (MIBC) after radical cystectomy (RC) in women. However, previous studies were conducted before neoadjuvant chemotherapy (NAC) was widely adopted to multidisciplinary management of MIBC. In our study, we assessed the gender-related difference in survival between patients who received NAC and those who underwent upfront RC, in two academic centers. This non-randomized, clinical follow-up study enrolled 1238 consecutive patients, out of whom 253 received NAC. We analyzed survival outcome of RC according to gender between NAC and non-NAC subgroups. We found that female gender was associated with inferior overall survival (OS), compared to males (HR, 1.234; 95%CI 1.046-1.447; = 0.013) in the overall cohort and in non-NAC patients with ≥pT2 disease (HR, 1.220 95%CI 1.009-1.477; = 0.041). However, no gender-specific difference was observed in patients exposed to NAC. The 5-year OS in NAC-exposed women in ≤pT1 and ≥pT2 disease, was 69.333% 95%CI (46.401-92.265) and 36.535% (13.134-59.936) respectively, compared to men 77.727% 95%CI (65.952-89.502) and 39.122% 95%CI (29.162-49.082), respectively. The receipt of NAC not only provides downstaging and prolongs patients' survival after radical treatment of MIBC but may also help to diminish the gender specific disparity.
有充分记录表明，女性肌层浸润性膀胱癌（MIBC）患者在根治性膀胱切除术（RC）后预后较差。然而，以往的研究是在新辅助化疗（NAC）被广泛应用于MIBC的多学科管理之前进行的。在我们的研究中，我们评估了两个学术中心接受NAC的患者与接受 upfront RC的患者之间的生存性别差异。这项非随机临床随访研究纳入了1238例连续患者，其中253例接受了NAC。我们根据NAC和非NAC亚组的性别分析了RC的生存结果。我们发现，在整个队列以及疾病≥pT2的非NAC患者中，女性的总生存期（OS）低于男性（HR，1.234；95%CI 1.046 - 1.447；P = 0.013）。然而，在接受NAC的患者中未观察到性别特异性差异。≤pT1和≥pT2疾病中接受NAC的女性患者的5年OS分别为69.333% 95%CI（46.401 - 92.265）和36.535%（13.134 - 59.936），而男性分别为77.727% 95%CI（65.952 - 89.502）和39.122% 95%CI（29.162 - 49.082）。接受NAC不仅能使MIBC根治性治疗后分期降低并延长患者生存期，还可能有助于减少性别特异性差异。
