Pignot Géraldine, Barthélémy Philippe, Borchiellini Delphine
Department of Surgical Oncology 2, Institut Paoli-Calmettes, 13009 Marseille, France.
Medical Oncology Unit, ICANS, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, France.
Cancers (Basel). 2024 Dec 7;16(23):4100. doi: 10.3390/cancers16234100.
Gender differences in prevalence, tumor invasiveness, response to treatment, and clinical outcomes exist in different types of cancer. The aim of this article is to summarize the sex disparities in bladder cancer diagnosis and treatment and try to suggest areas for improvement. Although men are at a higher risk of developing bladder tumors, women tend to be diagnosed with more advanced stages at diagnosis and are more likely to present with upfront muscle-invasive disease. Non-urothelial histological subtypes are more frequently reported in women. Regarding non-muscle-invasive bladder cancer (NMIBC), several studies have shown that women have a higher risk of disease recurrence after treatment with Bacillus Calmette-Guerin, due to different immunogenicities. In localized muscle-invasive bladder cancer (MIBC), neoadjuvant chemotherapy and cystectomy are less likely to be performed on women and sexual-sparing procedures with neobladder diversion are rarely offered. Finally, women appear to have a poorer prognosis than men, potentially due to the sex-associated intrinsic features of hosts and tumors that may drive differential therapeutic responses, particularly to immune-based therapies. Women are also more likely to develop severe adverse events related to systemic therapies and are underrepresented in randomized studies, leading to a gap between the real world and trials. In conclusion, studies investigating the role of sex and gender are urgently needed to improve the management of urothelial carcinoma.
不同类型癌症在患病率、肿瘤侵袭性、对治疗的反应及临床结果方面存在性别差异。本文旨在总结膀胱癌诊断与治疗中的性别差异，并尝试提出改进方向。尽管男性患膀胱肿瘤的风险更高，但女性在诊断时往往被诊断为更晚期，且更易出现初发的肌层浸润性疾病。女性中更常报告非尿路上皮组织学亚型。关于非肌层浸润性膀胱癌（NMIBC），多项研究表明，由于免疫原性不同，女性在接受卡介苗治疗后疾病复发风险更高。在局限性肌层浸润性膀胱癌（MIBC）中，女性接受新辅助化疗和膀胱切除术的可能性较小，采用新膀胱改道的保留性功能手术也很少提供。最后，女性的预后似乎比男性更差，这可能是由于宿主和肿瘤的性别相关内在特征可能导致不同的治疗反应，尤其是对免疫治疗的反应。女性也更易发生与全身治疗相关的严重不良事件，且在随机研究中的代表性不足，导致现实世界与试验之间存在差距。总之，迫切需要开展研究来调查性别在尿路上皮癌管理中的作用。
