title: The impact of gender on outcomes in patients with metastatic urothelial carcinoma.
abstract: BACKGROUND
  Although urothelial cancer is more common in men, women with urothelial cancer have inferior survival outcomes. The potential existence of gender-related disparities in patients with metastatic urothelial cancer has not been extensively explored.
  
  
  METHODS
  Individual patient data were pooled from 8 phase II and phase III trials evaluating first-line cisplatin-based combination chemotherapy in patients with metastatic urothelial carcinoma. Adverse events, treatment delivery, response proportions, and survival outcomes were compared between male and female patients.
  
  
  RESULTS
  Of the 543 patients included in the analysis, 100 patients (18%) were women. There was no significant difference in the number of cycles of chemotherapy administered or in the proportions of patients experiencing severe toxicities when comparing male and female patients. There was no difference in the survival distributions between male and female patients (P = .08); the median survival of male patients was 11.7 months (95% confidence interval [CI], 10.5-13.2) compared with 16.2 months for female patients (95% CI, 12.8-20.4). There was no significant difference in survival between men and women when controlling for baseline performance status and/or the presence of visceral metastases.
  
  
  CONCLUSIONS
  Female patients with metastatic urothelial cancer tolerate cisplatin-based chemotherapy similarly to male patients and achieve comparable clinical outcomes. Although gender-associated survival disparities in patients with metastatic urothelial cancer cannot be completely ruled out, if such disparities exist, they are unlikely related to tolerability or efficacy of chemotherapy.
authors.affiliation: Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Haines
authors.forename: Aristotle
authors.initials: A
authors.lastname: Bamias
authors.forename: Susan
authors.initials: S
authors.lastname: Krege
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Lin
authors.forename: Noah
authors.initials: N
authors.lastname: Hahn
authors.forename: Thorsten H
authors.initials: TH
authors.lastname: Ecke
authors.forename: Erin
authors.initials: E
authors.lastname: Moshier
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
authors.forename: James
authors.initials: J
authors.lastname: Godbold
authors.forename: William K
authors.initials: WK
authors.lastname: Oh
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Galsky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000188:drug therapy; D012737:Sex Factors; D013534:Survival; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D019459:Urothelium
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Bladder cancer; Chemotherapy; Cisplatin; Disparities; Gender; Metastatic; Urothelial cancer