title: Gender-specific differences in clinicopathologic outcomes following radical cystectomy: an international multi-institutional study of more than 8000 patients.
abstract: BACKGROUND
  The impact of gender on the staging and prognosis of urothelial carcinoma of the bladder (UCB) is insufficiently understood.
  
  
  OBJECTIVE
  To assess gender-specific differences in pathologic factors and survival of UCB patients treated with radical cystectomy (RC).
  
  
  METHODS
  Data from 8102 patients treated with RC (6497 men [80%] and 1605 women [20%]) for UCB between 1971 and 2012 were analyzed.
  
  
  METHODS
  Multivariable competing-risk regression analyses were performed to evaluate the relationship of gender on disease recurrence (DR) and cancer-specific mortality (CSM). We also tested the interaction of gender and tumor stage, nodal status, and lymphovascular invasion (LVI).
  
  
  CONCLUSIONS
  Female patients were older at the time of RC (p=0.033) and had higher rates of pathologic stage T3/T4 disease (p<0.001). In univariable, but not in multivariable analysis, female gender was associated with a higher risk of DR (p=0.022 and p=0.11, respectively). Female gender was an independent predictor for CSM (p=0.004). We did not find a significant interaction between gender and stage, nodal metastasis, or LVI (all p values >0.05).
  
  
  CONCLUSIONS
  We found female gender to be associated with a higher risk of CSM following RC. However, these findings do not appear to be explained by gender differences in pathologic stage, nodal status, or LVI. This gender disparity may be due to differences in care and/or the biology of UCB.
authors: Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Luis A
authors: LA
authors: Kluth
authors: Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Hospital Basel, Basel, Switzerland.
authors: Malte
authors: M
authors: Rieken
authors: Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
authors: Evanguelos
authors: E
authors: Xylinas
authors: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Matthew
authors: M
authors: Kent
authors: Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Michael
authors: M
authors: Rink
authors: Academic Department of Urology of la Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, University Paris VI, Faculté de médecine Pierre et Marie Curie, Paris, France.
authors: Morgan
authors: M
authors: Rouprêt
authors: Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Nasim
authors: N
authors: Sharifi
authors: Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
authors: Asha
authors: A
authors: Jamzadeh
authors: Department of Urology, McGill University, Montreal, QC, Canada.
authors: Wassim
authors: W
authors: Kassouf
authors: Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA.
authors: Dharam
authors: D
authors: Kaushik
authors: Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA.
authors: Stephen A
authors: SA
authors: Boorjian
authors: Department of Urology, Ruhr University Bochum, Marienhospital, Herne, Germany.
authors: Florian
authors: F
authors: Roghmann
authors: Department of Urology, Ruhr University Bochum, Marienhospital, Herne, Germany.
authors: Joachim
authors: J
authors: Noldus
authors: Department of Urology, Hôpital Henri Mondor Créteil, Créteil, France.
authors: Alexandra
authors: A
authors: Masson-Lecomte
authors: Department of Urology, Hôpital Henri Mondor Créteil, Créteil, France.
authors: Dimitri
authors: D
authors: Vordos
authors: Department of Urology, Kitasato University School of Medicine, Minami-ku, Sagamihara, Kanagawa, Japan.
authors: Masaomi
authors: M
authors: Ikeda
authors: Department of Urology, Kitasato University School of Medicine, Minami-ku, Sagamihara, Kanagawa, Japan.
authors: Kazumasa
authors: K
authors: Matsumoto
authors: Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
authors: Masayuki
authors: M
authors: Hagiwara
authors: Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
authors: Eiji
authors: E
authors: Kikuchi
authors: Department of Surgery (Urology), Laval University, Quebec, QC, Canada.
authors: Yves
authors: Y
authors: Fradet
authors: Department of Surgery (Urology), University of Western Ontario, London, ON, Canada.
authors: Jonathan
authors: J
authors: Izawa
authors: Department Urology, Dalhousie University, Halifax, NS, Canada.
authors: Ricardo
authors: R
authors: Rendon
authors: Department of Surgery (Urology), University of Alberta, Edmonton, AB, Canada.
authors: Adrian
authors: A
authors: Fairey
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Yair
authors: Y
authors: Lotan
authors: Department of Urology, University Hospital Basel, Basel, Switzerland.
authors: Alexander
authors: A
authors: Bachmann
authors: Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
authors: Marc
authors: M
authors: Zerbib
authors: Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Margit
authors: M
authors: Fisch
authors: Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
authors: Douglas S
authors: DS
authors: Scherr
authors: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Andrew
authors: A
authors: Vickers
authors: Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Division of Medical Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna, Austria. Electronic address: sfshariat@gmail.com.
authors: Shahrokh F
authors: SF
authors: Shariat
mesh_terms: D000368:Aged; D002170:Canada; D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005060:Europe; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019459:Urothelium / Q000473:pathology / Q000601:surgery*
keywords: Bladder cancer; Disease recurrence; Gender; Prognosis; Radical cystectomy; Survival