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.

Center for Medical Statistics Informatics and Intelligent Systems Medical University of Vienna Vienna Austria

Cross Cancer Institute Edmonton AB Canada; Department of Oncology University of Alberta Edmonton AB Canada

Department of Genitourinary Oncology H Lee Moffitt Cancer Center and Research Institute Tampa FL

Department of Genitourinary Oncology H Lee Moffitt Cancer Center and Research Institute Tampa FL; University of Auckland Auckland New Zealand

Department of Medicine Division of Oncology University of Washington School of Medicine and Fred Hutchinson Cancer Research Center Seattle WA

Department of Medicine Division of Oncology University of Washington School of Medicine and Fred Hutchinson Cancer Research Center Seattle WA; Department of Hematology and Medical Oncology Taussig Cancer Institute Cleveland Clinic Cleveland OH

Department of Surgery Exeter Surgical Health Services Research Unit Royal Devon and Exeter NHS Trust Exeter UK

Department of Surgery Exeter Surgical Health Services Research Unit Royal Devon and Exeter NHS Trust Exeter UK; Bristol Urological Institute North Bristol NHS Trust Bristol UK

Department of Surgery McGill University Health Center Montreal Canada

Department of Urologic Sciences University of British Columbia Vancouver BC Canada

Department of Urologic Sciences University of British Columbia Vancouver BC Canada; Western Health Melbourne Australia

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 Comprehensive Cancer Center Medical University of Vienna Vienna Austria; Department of Urology University of Texas Southwestern Medical Center Dallas TX; Departments of Urology Weill Cornell Medical College New York New York; Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic; Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Department of Urology Freeman Hospital Newcastle Upon Tyne UK

Department of Urology MD Anderson Cancer Center Houston TX

Department of Urology MD Anderson Cancer Center Houston TX; Department of Urology Stanford University School of Medicine Stanford CA

Department of Urology The James Buchanan Brady Urological Institute The Johns Hopkins School of Medicine Baltimore MD

Department of Urology The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands

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 Oklahoma College of Medicine Oklahoma City OK

Department of Urology University of Texas Southwestern Medical Center Dallas TX

Department of Urology University of Texas Southwestern Medical Center Dallas TX; Department of Urology University of Münster Münster Germany

Department of Urology University of Washington Seattle WA

Department of Urology Vanderbilt University Medical Center Nashville TN

Glickman Urological and Kidney Institute Cleveland Clinic Cleveland OH

Glickman Urological and Kidney Institute Cleveland Clinic Cleveland OH; Department of Urology Fundacion Instituto Valenciano de Oncologia Valencia Spain

Hertfordshire and Bedfordshire Urological Cancer Centre Department of Urology Lister Hospital Stevenage UK; Department of Urology Freeman Hospital Newcastle Upon Tyne UK

Princess Margaret Hospital Toronto ON Canada

University of Alberta Edmonton AB Canada

USC Norris Comprehensive Cancer Center Institute of Urology University of Southern California Los Angeles CA

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