CHU de Québec-Université Laval, Quebec City, Quebec, Canada.
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
Nat Rev Urol. 2024 Mar;21(3):181-192. doi: 10.1038/s41585-023-00806-2. Epub 2023 Aug 21.
The differences in bladder cancer outcomes between the sexes has again been highlighted. Uncommon among cancers, bladder cancer outcomes are notably worse for women than for men. Furthermore, bladder cancer is three to four times more common among men than among women. Factors that might explain these sex differences include understanding the importance of haematuria as a symptom of bladder cancer by both clinicians and patients, the resultant delays in diagnosis and referral of women with haematuria, and health-care access. Notably, these factors seem to have geographical variation and are not consistent across all health-care systems. Likewise, data relating to sex-specific treatment responses for patients with non-muscle-invasive or muscle-invasive bladder cancer are inconsistent. The influence of differences in the microbiome, bladder wall thickness and urine dwell times remain to be elucidated. The interplay of hormone signalling, gene expression, immunology and the tumour microenvironment remains complex but probably underpins the sexual dimorphism in disease incidence and stage and histology at presentation. The contribution of these biological phenomena to sex-specific outcome differences is probable, albeit potentially treatment-specific, and further understanding is required. Notwithstanding these aspects, we identify opportunities to harness biological differences to improve treatment outcomes, as well as areas of fundamental and translational research to pursue. At the level of policy and health-care delivery, improvements can be made across the domains of patient awareness, clinician education, referral pathways and guideline-based care. Together, we aim to highlight opportunities to close the sex gap in bladder cancer outcomes.
男女膀胱癌预后的差异再次凸显出来。膀胱癌的预后明显差于男性，这在癌症中较为罕见。此外，膀胱癌在男性中的发病率是女性的 3 至 4 倍。导致这些性别差异的因素包括临床医生和患者对血尿作为膀胱癌症状的重要性的认识、女性血尿患者诊断和转诊的延迟，以及医疗保健的可及性。值得注意的是，这些因素似乎存在地域差异，并且在所有医疗保健系统中并不一致。同样，与非肌肉浸润性或肌肉浸润性膀胱癌患者的性别特异性治疗反应相关的数据也不一致。微生物组、膀胱壁厚度和尿液停留时间的差异的影响仍有待阐明。激素信号、基因表达、免疫学和肿瘤微环境的相互作用仍然很复杂，但可能是疾病发病率和分期以及就诊时组织学的性别二态性的基础。这些生物学现象对性别特异性预后差异的影响可能是存在的，尽管可能是特定于治疗的，需要进一步的了解。尽管存在这些方面，我们仍确定了利用生物学差异来改善治疗结果的机会，以及需要开展基础和转化研究的领域。在政策和医疗保健提供层面，可以在患者意识、临床医生教育、转诊途径和基于指南的护理等领域进行改进。我们共同的目标是强调缩小膀胱癌预后性别差距的机会。
