title: Age-specific effect of gender on upper tract urothelial carcinoma outcomes.
abstract: The research is to evaluate the age-specific differential effects of gender on outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Between August 1998 and October 2010, we retrospectively reviewed the data from 285 (67.7%) men and 136 (32.3%) women treated with RNU for UTUC at our two institutions. Kaplan-Meier survival estimates the age-specific effect of gender on cancer-specific survival (CSS). Cox proportional hazards regression analyses were used to address the effect of gender on CSS. No significant sex-related differences were found in age and diagnosis, clinicopathologic features, and treatment (all P values >0.05). Women had a 18.7% increased risk of death from UTUC than men (hazard ratio [HR] 1.187; 95% confidence interval [95% CI] 1.017-1.893; P = 0.021). The survival disadvantage was only present in patients aged 59 years and older (P < 0.001). Conversely, the survival advantage for women was found in women aged 42 to 58 years (P = 0.011) and in the age group <42 years (P = 0.019). On multivariable Cox regression analyses that adjusted for the effects of clinicopathologic features, the female gender was associated with decreased CSS (P = 0.036). In conclusion, the impact of gender on UTUC outcomes after RNU is age-specific. Females who aged 59 years and older experienced worse outcomes than their male counterparts, while women in the age group <42 years and 42-58 years have better outcomes than men. Further research is needed to elucidate the molecular mechanisms underlying the age-specific differential effect of gender on UTUC outcomes.
authors.affiliation: State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong, People's Republic of China.
authors.forename: Jian-Ye
authors.initials: JY
authors.lastname: Liu
authors.forename: Yong-Hong
authors.initials: YH
authors.lastname: Li
authors.forename: Zhi-Ling
authors.initials: ZL
authors.lastname: Zhang
authors.forename: Yun-Lin
authors.initials: YL
authors.lastname: Ye
authors.forename: Zhou-Wei
authors.initials: ZW
authors.lastname: Liu
authors.forename: Kai
authors.initials: K
authors.lastname: Yao
authors.forename: Pei
authors.initials: P
authors.lastname: Dong
authors.forename: Sheng-Jie
authors.initials: SJ
authors.lastname: Guo
authors.forename: Li-Juan
authors.initials: LJ
authors.lastname: Jiang
authors.forename: Ming-Zhu
authors.initials: MZ
authors.lastname: Zhong
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Hui
authors.initials: H
authors.lastname: Han
authors.forename: Zi-Ke
authors.initials: ZK
authors.lastname: Qin
authors.forename: Fang-Jian
authors.initials: FJ
authors.lastname: Zhou
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D012727:Sex Characteristics; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D019459:Urothelium / Q000473:pathology* / Q000601:surgery