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Gender-dependent cancer-specific survival following radical cystectomy

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Abstract

Objective

To assess the impact of detailed clinical and histopathological criteria on gender-dependent cancer-specific survival (CSS) in a large consecutive series of patients following radical cystectomy (RCE) for muscle-invasive bladder cancer (MIBC).

Patients and methods

Between 1992 and 2007, 388 men and 133 women (25.5%) underwent RCE for MIBC. A prospectively maintained database was analysed retrospectively. Uni- and multivariable Cox-regression analyses calculated the impact of detailed clinical and histopathological criteria on CSS. Median follow-up was 59 months (2–162).

Results

Among clinical and histopathological parameters, only type of urinary diversion differed between men and women. In univariable analysis, CSS did not differ between genders. In multivariable Cox-regression analysis, advanced pT-stage (HR = 2.12; P < 0.001), lymphovascular invasion (LVI) (HR = 3.47; P < 0.001), time interval between diagnosis of MIBC and RCE exceeding 90 days (HR = 2.07; P < 0.001) and female gender (HR = 1.35; P = 0.048) were related to reduced CSS. In separate multivariable Cox-models for time period of surgery between 1992 an 1999 (HR = 1.52; P = 0.050), age ≤55 years (HR = 3.00; P = 0.022), presence of LVI (HR = 1.45; P = 0.031) and female gender were associated with independent reduced CSS.

Conclusion

Established clinical and histopathological parameters do not differ significantly between both genders in the present series. Reduced CSS in women is present in historic cohorts possibly suggesting improvement in management over the last years. In particular, female gender has a significant negative impact on CSS in patients younger of age and with positive LVI status possibly suggesting different clinical phenotypes.

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References

  1. Fajkovic H, Halpern JA, Cha EK, Bahadori A, Chromecki TF, Karakiewicz PI, Breinl E, Merseburger AS, Shariat SF (2011) Impact of gender on bladder cancer incidence, staging, and prognosis. World J Urol. [Epub ahead of print]

  2. Stenzl A, Cowan NC, De Santis M, Kuczyk MA, Merseburger AS, Ribal MJ, Sherif A, Witjes JA, European Association of Urology (EAU) (2011) Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur Urol 59(6):1009–1018

    Article  PubMed  CAS  Google Scholar 

  3. Horstmann M, Witthuhn R, Falk M, Stenzl A (2008) Gender-specific differences in bladder cancer: a retrospective analysis. Gend Med 5(4):385–394

    Article  PubMed  Google Scholar 

  4. Tilki D, Svatek RS, Novara G, Seitz M, Godoy G, Karakiewicz PI, Kassouf W, Fradet Y, Fritsche HM, Sonpavde G, Izawa JI, Ficarra V, Lerner SP, Schoenberg M, Stief CG, Dinney CP, Skinner E, Lotan Y, Sagalowsky AI, Reich O, Shariat SF (2010) Stage pT0 at radical cystectomy confers improved survival: an international study of 4,430 patients. J Urol 184(3):888–894

    Article  PubMed  Google Scholar 

  5. Mungan NA, Aben KK, Schoenberg MP, Visser O, Coebergh JW, Witjes JA, Kiemeney LA (2000) Gender differences in stage-adjusted bladder cancer survival. Urology 55(6):876–880

    Article  PubMed  CAS  Google Scholar 

  6. Scosyrev E, Noyes K, Feng C, Messing E (2009) Sex and racial differences in bladder cancer presentation and mortality in the US. Cancer 115(1):68–74

    Article  PubMed  Google Scholar 

  7. Tilki D, Svatek RS, Karakiewicz PI, Isbarn H, Reich O, Kassouf W, Fradet Y, Novara G, Fritsche HM, Bastian PJ, Izawa JI, Stief CG, Ficarra V, Lerner SP, Schoenberg M, Dinney CP, Skinner E, Lotan Y, Sagalowsky AI, Shariat SF (2010) Characteristics and outcomes of patients with pT4 urothelial carcinoma at radical cystectomy: a retrospective international study of 583 patients. J Urol 183(1):87–93

    Article  PubMed  Google Scholar 

  8. Shariat SF, Sfakianos JP, Droller MJ, Karakiewicz PI, Meryn S, Bochner BH (2010) The effect of age and gender on bladder cancer: a critical review of the literature. BJU Int 105(3):300–308

    Article  PubMed  Google Scholar 

  9. Scosyrev E, Trivedi D, Messing E (2010) Female bladder cancer: incidence, treatment, and outcome. Curr Opin Urol 20(5):404–408

    Article  PubMed  Google Scholar 

  10. Johnson EK, Daignault S, Zhang Y, Lee CT (2008) Patterns of haematuria referral to urologists: does a gender disparity exist? Urology 72(3):498–502

    Article  PubMed  Google Scholar 

  11. Gore JL, Lai J, Setodji CM, Litwin MS, Saigal CS, Urologic Diseases in America Project (2009) Mortality increases when radical cystectomy is delayed more than 12 weeks: results from a surveillance, epidemiology, and end results-medicare analysis. Cancer 115(5):988–996

    Article  PubMed  Google Scholar 

  12. May M, Nitzke T, Helke C, Vogler H, Hoschke B (2004) Significance of the time period between diagnosis of muscle invasion and radical cystectomy with regard to the prognosis of transitional cell carcinoma of the urothelium in the bladder. Scand J Urol Nephrol 38(3):231–235

    Article  PubMed  CAS  Google Scholar 

  13. Lee CT, Madii R, Daignault S, Dunn RL, Zhang Y, Montie JE, Wood DP Jr (2006) Cystectomy delay more than 3 months from initial bladder cancer diagnosis results in decreased disease specific and overall survival. J Urol 175(4):1262–1267

    Article  PubMed  Google Scholar 

  14. Maclennan SJ, Maclennan SJ, Imamura M, Omar MI, Vale L, Lam T, Royle P, Royle J, Swami S, Pickard R, McClinton S, Griffiths TR, Dahm P, N'dow J, The UCAN Care Pathway Development Group (2011) Urological cancer care pathways: development and use in the context of systematic reviews and clinical practice guidelines. World J Urol 29(3):291–301

    Article  PubMed  Google Scholar 

  15. Micheli A, Mariotto A, Giorgi Rossi A, Gatta G, Muti P (1998) The prognostic role of gender in survival of adult cancer patients. Eur J Cancer 34(14):2271–2278

    Article  PubMed  CAS  Google Scholar 

  16. Svatek RS, Shariat SF, Dinney CP, Novara G, Fradet Y, Bastian PJ, Kassouf W, Karakiewicz PI, Fritsche HM, Muller SC, Izawa JI, Skinner E, Stief CG, Ficarra V, Volkmer BG, Montorsi F, Isbarn H, Lerner SP, Sagalowsky AI, Schoenberg MP (2009) Evidence-based gender related outcomes after radical cystectomy: results of a large multicenter study. J Urol 181(4, Supplement 1):629

    Article  Google Scholar 

  17. Jeldres C, Isbarn H, Capitanio U, Baillargeon-Gagne S, Bhojani N, Shariat SF, Suardi N, Gallina A, Montorsi F, Saad F, Perrotte P, Karakiewicz PI (2009) Gender is an important predictor of cancer-specific survival in patient with transitional cell carcinoma after radical cystectomy. J Urol 181(4, Supplement 1):635

    Article  Google Scholar 

  18. Datta GD, Neville B, Datta NS, Earle C (2006) Gender disparities in bladder cancer survival: an assessment of sociodemographic factors. AACR Meet Abst B38

  19. Leliveld AM, Doornweerd BH, Bastiaannet E, Schaapveld M, de Jong IJ (2010) Treatment and outcome in muscle invasive bladder cancer: a population-based survey. World J Urol 28(4):439–444

    Article  PubMed  Google Scholar 

  20. Nagele U, Anastasiadis AG, Stenzl A, Kuczyk M (2011) Radical cystectomy with orthotopic neobladder for invasive bladder cancer: a critical analysis of long-term oncological, functional, and quality of life results. World J Urol. [Epub ahead of print]

  21. Sonpavde G, Khan MM, Lerner SP, Svatek RS, Novara G, Karakiewicz PI, Skinner E, Tilki D, Kassouf W, Fradet Y, Dinney CP, Fritsche HM, Izawa JI, Bastian PJ, Ficarra V, Schoenberg M, Sagalowsky AI, Lotan Y, Shariat SF (2011) Disease-free survival at 2 or 3 years correlates with 5-year overall survival of patients undergoing radical cystectomy for muscle invasive bladder cancer. J Urol 185(2):456–461

    Article  PubMed  Google Scholar 

  22. Shariat SF, Karakiewicz PI, Palapattu GS, Lotan Y, Rogers CG, Amiel GE, Vazina A, Gupta A, Bastian PJ, Sagalowsky AI, Schoenberg MP, Lerner SP (2006) Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the bladder cancer research consortium. J Urol 176(6 Pt 1):2414–2422 (discussion 2422)

    Article  PubMed  Google Scholar 

  23. Stein JP, Penson DF, Lee C, Cai J, Miranda G, Skinner DG (2009) Long-term oncological outcomes in women undergoing radical cystectomy and orthotopic diversion for bladder cancer. J Urol 181(5):2052–2058 (discussion 2058–2059)

    Article  PubMed  Google Scholar 

  24. May M, Helke C, Nitzke T, Vogler H, Hoschke B (2004) Survival rates after radical cystectomy according to tumor stage of bladder carcinoma at first presentation. Urol Int 72(2):103–111

    Article  PubMed  Google Scholar 

  25. Alkhateeb SS, Van Rhijn BW, Finelli A, van der Kwast T, Evans A, Hanna S, Vajpeyi R, Fleshner NE, Jewett MA, Zlotta AR (2010) Nonprimary pT1 nonmuscle invasive bladder cancer treated with bacillus Calmette-Guerin is associated with higher risk of progression compared to primary T1 tumors. J Urol 184(1):81–86

    Article  PubMed  Google Scholar 

  26. Shariat SF, Palapattu GS, Karakiewicz PI, Rogers CG, Vazina A, Bastian PJ, Schoenberg MP, Lerner SP, Sagalowsky AI, Lotan Y (2007) Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ-confined TCC at radical cystectomy. Eur Urol 51(1):152–160

    Article  PubMed  Google Scholar 

  27. Manoharan M, Katkoori D, Kishore TA, Jorda M, Luongo T, Soloway MS (2010) Lymphovascular invasion in radical cystectomy specimen: is it an independent prognostic factor in patients without lymph node metastases? World J Urol 28(2):233–237

    Article  PubMed  Google Scholar 

  28. Puente D, Malats N, Cecchini L, Tardón A, García-Closas R, Serra C, Carrato A, Sala M, Boixeda R, Dosemeci M, Real FX, Kogevinas M, EPICURO Study Group Investigators (2003) Gender-related differences in clinical and pathological characteristics and therapy of bladder cancer. Eur Urol 43(1):53–62

    Article  PubMed  CAS  Google Scholar 

  29. Mallin K, David KA, Carroll PR, Milowsky MI, Nanus DM (2011) Transitional cell carcinoma of the bladder: racial and gender disparities in survival (1993–2002), stage and grade (1993–2007). J Urol 185(5):1631–1636

    Article  PubMed  Google Scholar 

  30. May M, Herrmann E, Bolenz C, Tiemann A, Brookman-May S, Fritsche HM, Burger M, Buchner A, Gratzke C, Wülfing C, Trojan L, Ellinger J, Tilki D, Gilfrich C, Höfner T, Roigas J, Zacharias M, Gunia S, Wieland WF, Hohenfellner M, Michel MS, Haferkamp A, Müller SC, Stief CG, Bastian PJ (2011) Lymph node density affects cancer-specific survival in patients with lymph node-positive urothelial bladder cancer following radical cystectomy. Eur Urol. [Epub ahead of print]

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Conflict of interest

All authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Urology, St. Elisabeth Hospital, Straubing, Germany

    Matthias May & Christian Gilfrich

  2. Department of Urology, Ludwig-Maximilians-University, Munich, Germany

    Christian Stief

  3. Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany

    Sabine Brookman-May, Wolfgang Otto, Wolf F. Wieland, Hans-Martin Fritsche & Maximilian Burger

  4. Department of Urology, Vivantes-Hospital Am Urban and Friedrichshain, Berlin, Germany

    Jan Roigas

  5. Department of Urology, Vivantes-Hospital AVK, Berlin, Germany

    Mario Zacharias

  6. Institute of Pathology, University of Regensburg, Regensburg, Germany

    Ferdinand Hofstädter

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  1. Matthias May
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Correspondence to Maximilian Burger.

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May, M., Stief, C., Brookman-May, S. et al. Gender-dependent cancer-specific survival following radical cystectomy. World J Urol 30, 707–713 (2012). https://doi.org/10.1007/s00345-011-0773-1

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  • DOI: https://doi.org/10.1007/s00345-011-0773-1

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