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Impact of sex on response to neoadjuvant chemotherapy in patients with bladder cancer
D. D'Andrea, PC. Black, H. Zargar, K. Zargar-Shoshtari, S. Zehetmayer, AS. Fairey, LS. Mertens, CP. Dinney, MC. Mir, LM. Krabbe, MS. Cookson, NE. Jacobsen, JS. Montgomery, N. Vasdev, EY. Yu, E. Xylinas, NJ. Campain, W. Kassouf, MA. Dall'Era, JA....
Language English Country United States
Document type Journal Article
- MeSH
- Chemotherapy, Adjuvant methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Urinary Bladder Neoplasms drug therapy epidemiology MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Sex Factors MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
OBJECTIVE: To assess the effect of patient's sex on response to neoadjuvant chemotherapy (NAC) in patients with clinically nonmetastatic muscle-invasive bladder cancer (MIBC). METHODS: Complete pathologic response, defined as ypT0N0 at radical cystectomy, and downstaging were evaluated using sex-adjusted univariable and multivariable logistic regression modeling. We used interaction terms to account for age of menopause and smoking status. The association of sex with overall survival and cancer-specific survival was evaluated using Cox regression analyses. RESULTS: A total of 1,031 patients were included in the analysis, 227 (22%) of whom were female. Female patients had a higher rate of extravesical disease extension (P = 0.01). After the administration of NAC, ypT stage was equally distributed between sexes (P = 0.39). On multivariable logistic regression analyses, there was no difference between the sexes or age of menopause with regards to ypT0N0 rates or downstaging (all P > 0.5). On Cox regression analyses, sex was associated with neither overall survival (hazard ratio 1.04, 95% confidence interval 0.75-1.45, P = 0.81) nor cancer-specific survival (hazard ratio 1.06, 95% confidence interval 0.71-1.58, P = 0.77). CONCLUSION: Our study generates the hypothesis that NAC equalizes the preoperative disparity in pathologic stage between males and females suggesting a possible differential response between sexes. This might be the explanation underlying the comparable survival outcomes between sexes despite females presenting with more advanced tumor stage.
Bristol Urological Institute North Bristol NHS Trust Bristol UK
Cross Cancer Institute Edmonton AB Canada
Department of Genitourinary Oncology H Lee Moffitt Cancer Center and Research Institute Tampa FL
Department of Hematology and Medical Oncology Taussig Cancer Institute Cleveland Clinic Cleveland OH
Department of Oncology University of Alberta Edmonton AB Canada
Department of Surgery McGill University Health Center Montreal Canada
Department of Urologic Sciences University of British Columbia Vancouver BC Canada
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology Cochin Hospital APHP Paris Descartes University Paris France
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology Freeman Hospital Newcastle Upon Tyne UK
Department of Urology Fundacion Instituto Valenciano de Oncologia Valencia Spain
Department of Urology MD Anderson Cancer Center Houston TX
Department of Urology Stanford University School of Medicine Stanford CA
Department of Urology University of California at Davis Davis Medical Center Sacramento CA
Department of Urology University of Kansas Medical Center Kansas City KS
Department of Urology University of Michigan Health System Ann Arbor MI
Department of Urology University of Münster Münster Germany
Department of Urology University of Oklahoma College of Medicine Oklahoma City OK
Department of Urology University of Texas Southwestern Medical Center Dallas TX
Department of Urology University of Washington Seattle WA
Department of Urology Vanderbilt University Medical Center Nashville TN
Departments of Urology Weill Cornell Medical College New York New York
Glickman Urological and Kidney Institute Cleveland Clinic Cleveland OH
Princess Margaret Hospital Toronto ON Canada
University of Alberta Edmonton AB Canada
References provided by Crossref.org
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- $a OBJECTIVE: To assess the effect of patient's sex on response to neoadjuvant chemotherapy (NAC) in patients with clinically nonmetastatic muscle-invasive bladder cancer (MIBC). METHODS: Complete pathologic response, defined as ypT0N0 at radical cystectomy, and downstaging were evaluated using sex-adjusted univariable and multivariable logistic regression modeling. We used interaction terms to account for age of menopause and smoking status. The association of sex with overall survival and cancer-specific survival was evaluated using Cox regression analyses. RESULTS: A total of 1,031 patients were included in the analysis, 227 (22%) of whom were female. Female patients had a higher rate of extravesical disease extension (P = 0.01). After the administration of NAC, ypT stage was equally distributed between sexes (P = 0.39). On multivariable logistic regression analyses, there was no difference between the sexes or age of menopause with regards to ypT0N0 rates or downstaging (all P > 0.5). On Cox regression analyses, sex was associated with neither overall survival (hazard ratio 1.04, 95% confidence interval 0.75-1.45, P = 0.81) nor cancer-specific survival (hazard ratio 1.06, 95% confidence interval 0.71-1.58, P = 0.77). CONCLUSION: Our study generates the hypothesis that NAC equalizes the preoperative disparity in pathologic stage between males and females suggesting a possible differential response between sexes. This might be the explanation underlying the comparable survival outcomes between sexes despite females presenting with more advanced tumor stage.
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