title: Gender-specific survival following radical cystectomy for pT4 bladder cancer.
abstract: OBJECTIVE
  To evaluate the association of gender with survival following radical cystectomy (RC) for patients with pT4 bladder cancer.
  
  
  METHODS
  We reviewed our institutional registry of 2,088 patients treated with RC between 1980 and 2005 to identify 128 with pT4 tumors, including 91 males and 37 females. Survival was estimated using the Kaplan-Meier method and compared with log-rank test. Cox hazard regression models were used to analyze the association of clinicopathologic demographics, including gender, with outcome.
  
  
  RESULTS
  A total of 7 women and 30 men with pT4 tumor received perioperative chemotherapy. Median postoperative follow-up was 10.5 years, during which time 27 patients experienced local recurrence (LR) and 120 died, including 90 who died from bladder cancer. Women with pT4 tumor trended to have higher 5-year LR-free survival (72 vs. 59 %; p = 0.83), cancer-specific survival (31 vs. 17 %; p = 0.50), and overall survival (19 vs. 11 %; p = 0.33), although these differences did not reach statistical significance. On multivariate analysis, moreover, gender was not significantly associated with LR (HR 0.96; p = 0.93), cancer-specific mortality (HR 1.05; p = 0.87), or all-cause mortality (ACM) (HR 1.14; p = 0.58). Instead, poor ECOG performance status and pN+ disease were associated with an increased risk of ACM, while removal of a greater number of lymph nodes was associated with decreased ACM.
  
  
  CONCLUSIONS
  We did not find gender-specific disparities in survival following RC for pT4 bladder cancer. Prognosis was instead driven by patient performance status and lymph node status.
authors.affiliation: Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA, drdkuro@gmail.com.
authors.forename: Dharam
authors.initials: D
authors.lastname: Kaushik
authors.forename: Igor
authors.initials: I
authors.lastname: Frank
authors.forename: Manuel S
authors.initials: MS
authors.lastname: Eisenberg
authors.forename: John C
authors.initials: JC
authors.lastname: Cheville
authors.forename: Robert
authors.initials: R
authors.lastname: Tarrell
authors.forename: Prabin
authors.initials: P
authors.lastname: Thapa
authors.forename: R Houston
authors.initials: RH
authors.lastname: Thompson
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D012737:Sex Factors; D016019:Survival Analysis; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*