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The Effect of Sex on Disease Stage and Survival after Radical Cystectomy in Non-Urothelial Variant-Histology Bladder Cancer
RS. Flammia, A. Tufano, F. Chierigo, C. Würnschimmel, B. Hoeh, G. Sorce, Z. Tian, U. Anceschi, C. Leonardo, F. Del Giudice, C. Terrone, A. Giordano, A. Morrione, F. Saad, SF. Shariat, A. Briganti, F. Montorsi, FKH. Chun, M. Gallucci, PI. Karakiewicz
Status not-indexed Language English Country Switzerland
Document type Journal Article
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PubMed
36902562
DOI
10.3390/jcm12051776
Knihovny.cz E-resources
- Publication type
- Journal Article MeSH
BACKGROUND: Female sex in patients treated by radical cystectomy (RC) is associated with more advanced stage and worse survival. However, studies supporting these findings mostly or exclusively relied on urothelial carcinoma of the urinary bladder (UCUB) and did not address non-urothelial variant-histology bladder cancer (VH BCa). We hypothesized that female sex is associated with a more advanced stage and worse survival in VH BCa, similarly to that of UCUB. MATERIALS AND METHODS: Within the SEER database (2004-2016), we identified patients aged ≥18 years, with histologically confirmed VH BCa, and treated with comprehensive RC. Logistic regression addressing the non-organ-confined (NOC) stage, as well as cumulative incidence plots and competing risks regression addressing CSM for females vs. males, were fitted. All analyses were repeated in stage-specific and VH-specific subgroups. RESULTS: Overall, 1623 VH BCa patients treated with RC were identified. Of those, 38% were female. Adenocarcinoma (n = 331, 33%), neuroendocrine tumor (n = 304, 18%), and other VH (n = 317, 37%) were less frequent in females but not squamous cell carcinoma (n = 671, 51%). Across all VH subgroups, female patients had higher NOC rates than males did (68 vs. 58%, p < 0.001), and female sex was an independent predictor of NOC VH BCa (OR = 1.55, p = 0.0001). Overall, five-year cancer-specific mortality (CSM) were 43% for females vs. 34% for males (HR = 1.25, p = 0.02). CONCLUSION: In VH BC patients treated with comprehensive RC, female sex is associated with a more advanced stage. Independently of stage, female sex also predisposes to higher CSM.
Department of Medical Biotechnology University of Siena 53100 Siena Italy
Department of Surgical and Diagnostic Integrated Sciences University of Genova 16146 Genova Italy
Department of Urology 2nd Faculty of Medicine Charles University 128 08 Prague Czech Republic
Department of Urology Comprehensive Cancer Center Medical University of Vienna 1090 Vienna Austria
Department of Urology Regina Elena National Cancer Institute 00144 Rome Italy
Department of Urology University of Texas Southwestern Dallas TX 75390 USA
Department of Urology Weill Cornell Medical College New York NY 10065 USA
Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman 11942 Jordan
Martini Klinik Prostate Cancer Center University Hospital Hamburg Eppendorf 20251 Hamburg Germany
References provided by Crossref.org
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- $a Flammia, Rocco Simone $u Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy $u Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H4A 3J1, Canada $1 https://orcid.org/0000000231290544
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- $a BACKGROUND: Female sex in patients treated by radical cystectomy (RC) is associated with more advanced stage and worse survival. However, studies supporting these findings mostly or exclusively relied on urothelial carcinoma of the urinary bladder (UCUB) and did not address non-urothelial variant-histology bladder cancer (VH BCa). We hypothesized that female sex is associated with a more advanced stage and worse survival in VH BCa, similarly to that of UCUB. MATERIALS AND METHODS: Within the SEER database (2004-2016), we identified patients aged ≥18 years, with histologically confirmed VH BCa, and treated with comprehensive RC. Logistic regression addressing the non-organ-confined (NOC) stage, as well as cumulative incidence plots and competing risks regression addressing CSM for females vs. males, were fitted. All analyses were repeated in stage-specific and VH-specific subgroups. RESULTS: Overall, 1623 VH BCa patients treated with RC were identified. Of those, 38% were female. Adenocarcinoma (n = 331, 33%), neuroendocrine tumor (n = 304, 18%), and other VH (n = 317, 37%) were less frequent in females but not squamous cell carcinoma (n = 671, 51%). Across all VH subgroups, female patients had higher NOC rates than males did (68 vs. 58%, p < 0.001), and female sex was an independent predictor of NOC VH BCa (OR = 1.55, p = 0.0001). Overall, five-year cancer-specific mortality (CSM) were 43% for females vs. 34% for males (HR = 1.25, p = 0.02). CONCLUSION: In VH BC patients treated with comprehensive RC, female sex is associated with a more advanced stage. Independently of stage, female sex also predisposes to higher CSM.
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