title: Gender-dependent cancer-specific survival following radical cystectomy.
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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Urology, St. Elisabeth Hospital, Straubing, Germany.
authors: Matthias
authors: M
authors: May
authors: Christian
authors: C
authors: Stief
authors: Sabine
authors: S
authors: Brookman-May
authors: Wolfgang
authors: W
authors: Otto
authors: Christian
authors: C
authors: Gilfrich
authors: Jan
authors: J
authors: Roigas
authors: Mario
authors: M
authors: Zacharias
authors: Wolf F
authors: WF
authors: Wieland
authors: Hans-Martin
authors: HM
authors: Fritsche
authors: Ferdinand
authors: F
authors: Hofstädter
authors: Maximilian
authors: M
authors: Burger
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D017678:Sex Distribution; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000401:mortality; D019459:Urothelium / Q000473:pathology / Q000601:surgery