Li Yi Hong, Ou Yen-Chuan, Tung Min Che, Lin Yi Sheng, Yang Ya Chu, Chiu Ying Ming, Hsu Chao Yu
Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.
Doctoral Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
PLoS One. 2025 Jun 4;20(6):e0323803. doi: 10.1371/journal.pone.0323803. eCollection 2025.
The aim of this study was to elucidate the disparities in life expectancy, loss-of-life expectancy, and lifetime medical expenditure between sexes in patients with bladder cancer.
In this retrospective study, we used three Taiwanese databases to analyze the data of patients diagnosed with bladder cancer between 2008 and 2019. Patients aged <30 years or >90 years were excluded. Survival and lifetime costs were estimated using the Kaplan-Meier and semiparametric methods. Subgroup analyses were performed to examine the effects of cancer stage, age, and factors such as hemodialysis on patient outcomes and costs.
This study included 30,390 new diagnoses of bladder cancer. Disparities in loss-of-life expectancy between men and women were observed in both non-muscle-invasive bladder cancer (3.17 [0.55] years for men vs. 7.14 [0.76] years for women) and muscle-invasive bladder cancer (8.86 [0.43] years for men vs. 10.64 [0.63] years for women). Carcinoma in situ revealed its profound impact, with the associated loss-of-life expectancy mirroring those of advanced stages (combined sex carcinoma in situ: 8.58 years, stage 2 men: 9.48 years, stage 2 women: 9.53 years). The cost per life-year showed a marked difference, especially for non-muscle-invasive bladder cancer ($4,631 for men vs. $7,636 for women) and muscle-invasive bladder cancer ($6,033 for men vs. $7,753 for women). Hemodialysis accounted for a significant portion of these costs, with hemodialysis rates of 4.6% in men and 18.5% in women.
Women have a higher prevalence of high-grade histopathology and an extended duration of hemodialysis, culminating in inferior outcomes in non-muscle-invasive bladder cancer and muscle-invasive bladder cancer and augmented costs, compared with men. The role of hemodialysis and the carcinoma in situ stage highlights the need for vigilant monitoring and early aggressive treatment strategies.
本研究旨在阐明膀胱癌患者男女之间在预期寿命、寿命损失和终身医疗支出方面的差异。
在这项回顾性研究中，我们使用了三个台湾数据库来分析2008年至2019年间被诊断为膀胱癌的患者数据。排除年龄小于30岁或大于90岁的患者。使用Kaplan-Meier法和半参数法估计生存率和终身成本。进行亚组分析以检查癌症分期、年龄和血液透析等因素对患者结局和成本的影响。
本研究纳入了30390例新诊断的膀胱癌患者。在非肌层浸润性膀胱癌（男性预期寿命损失3.17[0.55]年，女性为7.14[0.76]年）和肌层浸润性膀胱癌（男性预期寿命损失8.86[0.43]年，女性为10.64[0.63]年）中均观察到男女预期寿命损失的差异。原位癌显示出其深远影响，相关的预期寿命损失与晚期相似（两性原位癌综合：8.58年，2期男性：9.48年，2期女性：9.53年）。每生命年成本存在显著差异，尤其是在非肌层浸润性膀胱癌（男性为4631美元，女性为7636美元）和肌层浸润性膀胱癌（男性为6033美元，女性为7753美元）中。血液透析占这些成本的很大一部分，男性血液透析率为4.6%，女性为18.5%。
与男性相比，女性高级别组织病理学的患病率更高，血液透析持续时间更长，导致非肌层浸润性膀胱癌和肌层浸润性膀胱癌的结局较差且成本增加。血液透析和原位癌阶段的作用凸显了进行密切监测和早期积极治疗策略的必要性。
