Abstract
The research is to evaluate the age-specific differential effects of gender on outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Between August 1998 and October 2010, we retrospectively reviewed the data from 285 (67.7 %) men and 136 (32.3 %) women treated with RNU for UTUC at our two institutions. Kaplan–Meier survival estimates the age-specific effect of gender on cancer-specific survival (CSS). Cox proportional hazards regression analyses were used to address the effect of gender on CSS. No significant sex-related differences were found in age and diagnosis, clinicopathologic features, and treatment (all P values >0.05). Women had a 18.7 % increased risk of death from UTUC than men (hazard ratio [HR] 1.187; 95 % confidence interval [95 % CI] 1.017–1.893; P = 0.021). The survival disadvantage was only present in patients aged 59 years and older (P < 0.001). Conversely, the survival advantage for women was found in women aged 42 to 58 years (P = 0.011) and in the age group <42 years (P = 0.019). On multivariable Cox regression analyses that adjusted for the effects of clinicopathologic features, the female gender was associated with decreased CSS (P = 0.036). In conclusion, the impact of gender on UTUC outcomes after RNU is age-specific. Females who aged 59 years and older experienced worse outcomes than their male counterparts, while women in the age group <42 years and 42–58 years have better outcomes than men. Further research is needed to elucidate the molecular mechanisms underlying the age-specific differential effect of gender on UTUC outcomes.
Similar content being viewed by others
References
Hall MC, Womack S, Sagalowsky AI, Carmody T, Erickstad MD, Roehrborn CG. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology. 1998;52:594–601.
Novara G, De Marco V, Gottardo F, Dalpiaz O, Bouygues V, Galfano A, et al. Independent predictors of cancer-specific survival in transitional cell carcinoma of the upper urinary tract: multi-institutional dataset from 3 European centers. Cancer. 2007;110:1715–22.
Cha EK, Shariat SF, Kormaksson M, Novara G, Chromecki TF, Scherr DS, et al. Predicting clinical outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol. 2012;61:818–25.
Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, et al. Outcomes of radical nephroureterectomy: a series from the upper tract urothelial carcinoma collaboration. Cancer. 2009;115:1224–33.
Roupret M, Zigeuner R, Palou J, Boehle A, Kaasinen E, Sylvester R, et al. European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur Urol. 2011;59:584–94.
Munoz JJ, Ellison LM. Upper tract urothelial neoplasms: incidence and survival during the last 2 decades. J Urol. 2000;164:1523–5.
Mungan NA, Aben KK, Schoenberg MP, Visser O, Coebergh JW, Witjes JA, et al. Gender differences in stage-adjusted bladder cancer survival. Urology. 2000;55:876–80.
Puente D, Malats N, Cecchini L, Tardon A, Garcia-Closas R, Serra C, et al. Gender-related differences in clinical and pathological characteristics and therapy of bladder cancer. Eur Urol. 2003;43:53–62.
Mungan NA, Kiemeney LA, van Dijck JA, van der Poel HG, Witjes JA. Gender differences in stage distribution of bladder cancer. Urology. 2000;55:368–71.
Lughezzani G, Sun M, Perrotte P, Shariat SF, Jeldres C, Budaus L, et al. Gender-related differences in patients with stage I to III upper tract urothelial carcinoma: results from the surveillance, epidemiology, and end results database. Urology. 2010;75:321–7.
Cheng HL, Chow NH, Tzai TS, Tong YC, Lin JS, Chan SH, et al. Prognostic significance of proliferating cell nuclear antigen expression in transitional cell carcinoma of the upper urinary tract. Anticancer Res. 1997;17:2789–93.
Li CC, Chang TH, Wu WJ, Ke HL, Huang SP, Tsai PC, et al. Significant predictive factors for prognosis of primary upper urinary tract cancer after radical nephroureterectomy in Taiwanese patients. Eur Urol. 2008;54:1127–34.
Koga F, Nagamatsu H, Ishimaru H, Mizuo T, Yoshida K. Risk factors for the development of bladder transitional cell carcinoma following surgery for transitional cell carcinoma of the upper urinary tract. Urol Int. 2001;67:135–41.
McGrath M, Michaud DS, De Vivo I. Hormonal and reproductive factors and the risk of bladder cancer in women. Am J Epidemiol. 2006;163:236–44.
Shin A, Song YM, Yoo KY, Sung J. Menstrual factors and cancer risk among Korean women. Int J Epidemiol. 2011;40:1261–8.
Frederick L, Greene DLP, Irvin D, April Fritz, Charles Balch M, Daniel Haller G, Monica Morrow. Fleming, April Fritz, Charles M Balch, Daniel G Haller, Monica Morrow. American Joint Committee on Cancer (AJCC) staging manual. 6th editor. Philadelphia: Springer; 2002.
Epstein JI, Amin MB, Reuter VR, Mostofi FK. The world health organization/international society of urological pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder. Bladder consensus conference committee. Am J Surg Pathol. 1998;22:1435–48.
Novara G, Matsumoto K, Kassouf W, Walton TJ, Fritsche HM, Bastian PJ, et al. Prognostic role of lymphovascular invasion in patients with urothelial carcinoma of the upper urinary tract: an international validation study. Eur Urol. 2010;57:1064–71.
MD VLK, MD GL, MD RAL, MD DG. Comprehensive gynecology: text with online access [Comprehensive Gynecology (Mishell/Herbst)]. 5th ed. Mosby; 2007; p. 1128.
Fernandez MI, Shariat SF, Margulis V, Bolenz C, Montorsi F, Suardi N, et al. Evidence-based sex-related outcomes after radical nephroureterectomy for upper tract urothelial carcinoma: results of large multicenter study. Urology. 2009;73:142–6.
Shariat SF, Favaretto RL, Gupta A, Fritsche HM, Matsumoto K, Kassouf W, et al. Gender differences in radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol. 2011;29:481–6.
Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011;61:212–36.
Harichand-Herdt S, Ramalingam SS. Gender-associated differences in lung cancer: clinical characteristics and treatment outcomes in women. Semin Oncol. 2009;36:572–80.
Hsieh CC, Trichopoulos D, Katsouyanni K, Yuasa S. Age at menarche, age at menopause, height and obesity as risk factors for breast cancer: associations and interactions in an international case-control study. Int J Cancer. 1990;46:796–800.
Dietrich K, Demidenko E, Schned A, Zens MS, Heaney J, Karagas MR. Parity, early menopause and the incidence of bladder cancer in women: a case-control study and meta-analysis. Eur J Cancer. 2011;47:592–9.
Conflict of interest
All authors have no any financial disclosures and conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Liu, JY., Li, YH., Zhang, ZL. et al. Age-specific effect of gender on upper tract urothelial carcinoma outcomes. Med Oncol 30, 640 (2013). https://doi.org/10.1007/s12032-013-0640-6
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s12032-013-0640-6