title: Gender differences in radical nephroureterectomy for upper tract urothelial carcinoma.
abstract: OBJECTIVE
  Women have been associated with adverse outcomes after radical cystectomy for lower tract urothelial carcinoma. We evaluated the prognostic value of gender in an international cohort of patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
  
  
  METHODS
  We retrospectively studied 754 patients treated with RNU for UTUC without neoadjuvant chemotherapy at nine centers located in Asia, Canada, and Europe. Univariable and multivariable Cox regression analyses were used to address recurrence-free (RFS) and cancer-specific survival (CSS) estimates. Median follow-up was 40 months (interquartile range: 18-75).
  
  
  RESULTS
  The majority of patients was of men (516, 68.4%). Women were older than men at the time of RNU (median: 69.2 vs. 66.5 years; P = 0.0003). Women were less likely to have high-grade disease, undergo lymph node dissection, and to receive adjuvant chemotherapy. Gender was not associated with pathologic stage, lymph node metastasis, lymphovascular invasion, concomitant CIS, tumor architecture, or tumor necrosis. On univariable Cox regression analyses, there was no association between gender and cancer recurrence (P = 0.76) or cancer-specific mortality (P = 0.30). On multivariable Cox regression analyses that adjusted for the effects of clinicopathologic features, gender was not associated with disease recurrence (P = 0.47) or cancer-specific survival (P = 0.15).
  
  
  CONCLUSIONS
  We found no difference in histopathologic features and outcomes between men and women treated with RNU for UTUC. Nevertheless, epidemiologic and mechanistic molecular studies should be encouraged to design, analyze, and report gender-specific associations to aid in our understanding of gender impact on UTUC incidence, progression, and metastasis.
authors.affiliation: Department of Urology and Medical Oncology, Brady Urologic Health Center, Weill Cornell Medical College, 525 East 68th Street, Starr 900, New York, NY 10065, USA. sfs2002@med.cornell.edu
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Ricardo L
authors.initials: RL
authors.lastname: Favaretto
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walton
authors.forename: Stefan
authors.initials: S
authors.lastname: Tritschler
authors.forename: Shiro
authors.initials: S
authors.lastname: Baba
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Matsushita
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Juan I
authors.initials: JI
authors.lastname: Martínez-Salamanca
authors.forename: Christian
authors.initials: C
authors.lastname: Seitz
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Otto
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009399:Nephrons / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D013624:Taiwan; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D019459:Urothelium / Q000473:pathology