Effect of Sex on Prognosis of Urothelial Carcinoma: Propensity Score Matching Analysis

doi:10.1016/j.clgc.2014.09.006

Clinical Genitourinary Cancer

Volume 13, Issue 2, April 2015, Pages e113-e121

https://doi.org/10.1016/j.clgc.2014.09.006 Get rights and content

Abstract

Background

The aim of the present study was to evaluate the effect of differences between the sexes on the prognosis of urothelial carcinoma after adjusting for other factors by using propensity score matching.

Patients and Methods

Between 2000 and 2011, 678 consecutive patients who had undergone radical cystectomy or radical nephroureterectomy for urothelial carcinoma were enrolled in this study. Propensity score methodology was used to adjust for selection bias with 10 and 12 perioperative variables for urothelial carcinoma of the bladder (UCB) and upper tract urothelial carcinoma (UTUC). By a 2:1 male-to-female patient matching ratio, we selected 38 and 66 pairs of patients with UCB and UTUC.

Results

The number of male patients was 573 (84.5%), and there were 105 female patients (15.5%). The mean follow-up was 55.5 ± 38.4 months. There were no significant differences in the perioperative variables of age, pathologic T (pT) stage, grade, lymphovascular invasion (LVI), and concomitant carcinoma in situ (CIS) between the sexes. Neither cancer-specific survival (CSS) or overall survival (OS) was associated with sex in a multivariate Cox proportional hazard model. In propensity score matching analysis, female sex was not an independent risk factor for CSS and OS in urothelial carcinoma. In patients with UCB, body mass index (BMI) and pT stage were independently associated with CCS. For the patients with UTUC, age, pT stage, LVI, adjuvant chemotherapy, bladder cuffing, and location were significantly correlated.

Conclusion

After adjusting for other risk factors with propensity score matching, female sex may not be an independent risk factor in prognosis for urothelial carcinoma (UC).

Introduction

The prevalence of urothelial carcinoma (UC) is different for men and women. It is the seventh most common cancer in men but the 17th most common in women worldwide.¹ Men have a 2- to 4-fold higher UC risk compared with women.² This can be explained by the difference in the intersexual smoking rate and the higher exposure to occupational carcinogens in men.¹ The biological differences between men and women can also contribute to the incidence of UC. There are recent reports claiming that sex hormones are involved in the development of UC,3, 4, 5, 6, 7 but the mechanisms of the hormone effect have been poorly understood.

The incidence of UC of the bladder (UCB) was reported to be lower and the mortality rate was found to be higher in women than in men.⁸ For social, cultural, and medical reasons, women tend to visit hospitals after delays, and they tend to have advanced disease and higher age at the time of the diagnosis compared with men.⁹ There is a report that the anatomic and hormonal differences between men and women have an effect on the prognosis, such as recurrence, progression, or cancer-specific survival.⁶ However, this difference in the prognosis between men and women is still at the hypothesis level, and a clear theoretical background has not yet been established.¹

Because upper tract urothelial carcinoma (UTUC) is a relatively uncommon disease and is considered to have biological characteristics similar to those of UCB, the characteristics of UTUC have been derived by extrapolation from UCB.¹⁰ It is documented that UTUC is also about twice as common in men as in women.¹¹ In previous studies, sex did not affect the prognosis of UTUC after adjusting for stage and grade.12, 13 The effect of sex on the prognosis of UTUC has not yet been fully investigated. The aim of the present study was to evaluate the effect of sex differences on prognosis in UC after adjusting for other factors by using propensity score matching.

Section snippets

Patients

Between 2000 and 2011, 712 consecutive patients who had undergone radical cystectomy or radical nephroureterectomy for UC were enrolled in the present study. After the approval of our institutional review board, patient information was collected through review of the computerized medical chart database. Among those reviewed, 16 patients who had other pathologic conditions such as adenocarcinoma or squamous cell carcinoma were excluded from the study. Additionally, 18 patients with incomplete

Results

A total of 678 patients who underwent radical cystectomy or radical nephroureterectomy for UC were selected for the present study, which included 573 male patients (84.5% [320 UCB cases and 253 UTUC cases]) and 105 female patients (15.5% [38 UCB cases and 66 UTUC cases]). There were no differences in the perioperative variables of age, pT stage, grade, LVI, and concomitant CIS between the sexes (Table 1, Table 2). The mean follow-up duration was 55.5 ± 38.4 months.

Discussion

In the present study, after adjusting other risk factors for UC with propensity score matching, female sex was not found to be an independent risk factor for prognosis after radical cystectomy or radical nephroureterectomy. To our knowledge, this is the first long-term large observational cohort study evaluating the effect of purely biological differences between the sexes.

In 2013, a new case of UCB was diagnosed in 54,610 male and 17,960 female patients in the United States.²⁰ This shows that

Conclusion

In the present study, we demonstrated that female sex may not be an independent risk factor for prognosis in UC after adjusting for other risk factors with propensity score matching. Biological differences between the sexes were not associated with CCS and OS after radical cystectomy or radical nephroureterectomy for the patients with UC. A higher pT stage of 3 or 4 was the common risk factor for worse prognosis in UCB and UTUC.

Disclosure

The authors have stated that they have no conflicts of interest.

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To assess the trend of incidence and survival stratified by age, race, gender and SES and the differences in time between groups in stage III–IV upper tract urothelial carcinoma (UTUC) patients.
7,505 stage III–IV UTUC patients between 2004 and 2015 were extracted from the Surveillance, Epidemiology and End Results (SEER) database. The overall survival (OS) and the cancer-specific survival (CSS) rates were assessed using the Kaplan-Meier curve and log-rank test as well as multivariate Cox regression analysis.
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2022, Frontiers in Oncology
Sex Differences in the Survival of Patients Undergoing Maintenance Hemodialysis: A 10-year Outcome of the Q-Cohort Study
2021, Research Square

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Original StudyEffect of Sex on Prognosis of Urothelial Carcinoma: Propensity Score Matching Analysis

Abstract

Background

Patients and Methods

Results

Conclusion

Introduction

Section snippets

Patients

Results

Discussion

Conclusion

Disclosure

Eur Urol

J Steroid Biochem

J Urol

Urol Oncol

Urology

Eur Urol

Urology

Gend Med

J Urol

J Urol

Eur Urol

Hormonal and reproductive factors and the risk of bladder cancer in women

Am J Epidemiol

Gender-specific differences in muscle-invasive bladder cancer: the concept of sex steroid sensitivity

World J Urol

Androgen receptor signals regulate UDP-glucuronosyltransferases in the urinary bladder: a potential mechanism of androgen-induced bladder carcinogenesis

Mol Carcinog

Evolution of the concept of androgen-sensitive bladder cancer

Scand J Urol

Original Study
Effect of Sex on Prognosis of Urothelial Carcinoma: Propensity Score Matching Analysis