title: Female sex is an independent risk factor for reduced overall survival in bladder cancer patients treated by transurethral resection and radio- or radiochemotherapy.
abstract: OBJECTIVE
  To evaluate sex as a possible prognostic factor in bladder cancer patients treated with transurethral resection (TURBT) and radio- (RT) or radiochemotherapy (RCT).
  
  
  METHODS
  Kaplan-Meier analyses and multiple Cox proportional hazards regression analyses were performed to analyze sex as a possible prognostic factor on the overall (OS) and cancer-specific (CSS) survival of 386 male and 105 female patients who underwent TURBT and RCT or RT with curative intent between 1982 and 2007.
  
  
  RESULTS
  After a follow-up of 5 years, female sex demonstrated a hazard ratio (HR) of 1.79 (95 % CI 1.24-2.57) for OS; for CSS, the HR was 2.4 (95 % CI 1.52-3.80). Sex was an adverse prognosticator of both OS and CSS independent from age at diagnosis, cT stage, grading, concurrent cis, LVI, focality, therapy response, resection status and therapy mode. Kaplan-Meier analysis showed significantly reduced OS of women compared with men, with a median survival of 2.3 years for female patients and 5.1 years for male patients (p = 0.045, log-rank test). The estimated median CSS was 7.1 years for female patients and 12.7 years for male patients (p = 0.11, log-rank test).
  
  
  CONCLUSIONS
  Female sex is an independent prognostic factor for reduced OS and CSS in bladder cancer patients treated by TURBT and RT or RCT. These data are in agreement with those reported for OS after radical cystectomy in muscle-invasive bladder cancers. Therefore, further studies are strongly warranted to obtain more information about molecular differences regarding sex-specific carcinogenesis in bladder cancer and about possible therapeutic considerations.
authors.affiliation: Department of Urology, University Hospital Erlangen, Universitätsstraße 12, 91052, Erlangen, Germany, bastian.keck@uk-erlangen.de.
authors.forename: Bastian
authors.initials: B
authors.lastname: Keck
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Ott
authors.forename: Lothar
authors.initials: L
authors.lastname: Häberle
authors.forename: Frank
authors.initials: F
authors.lastname: Kunath
authors.forename: Christian
authors.initials: C
authors.lastname: Weiss
authors.forename: Claus
authors.initials: C
authors.lastname: Rödel
authors.forename: Rolf
authors.initials: R
authors.lastname: Sauer
authors.forename: Rainer
authors.initials: R
authors.lastname: Fietkau
authors.forename: Bernd
authors.initials: B
authors.lastname: Wullich
authors.forename: Frens S
authors.initials: FS
authors.lastname: Krause
mesh_terms: D000368:Aged; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D013520:Urologic Surgical Procedures