Female gender is associated with a worse survival after radical cystectomy for urothelial carcinoma of the bladder: a competing risk analysis.
OBJECTIVE
To determine the association of gender with outcome after radical cystectomy for patients with bladder cancer.


METHODS
An observational cohort study was conducted using retrospectively collected data from 11 centers on patients with advanced bladder cancer treated with radical cystectomy. The association of gender with disease recurrence and cancer-specific mortality was examined using a competing risk analysis.


RESULTS
The study comprised 4296 patients, including 890 women (21%). The median follow-up duration was 31.5 months for all patients. Disease recurred in 1430 patients (33.9%) (36.8% of women and 33.1% of men) at a median of 11 months after surgery. Death from any cause was observed in 46.0% of men and 50.1% of women. Cancer-specific death was observed in 33.0% of women and 27.2% of men. Multivariable regression with competing risk found that female gender was associated with an increased risk for disease recurrence and cancer-specific mortality (hazard ratio, 1.27; 95% confidence interval, 1.108-1.465; P = .007) compared with male gender. Important limitations include the inability to account for additional potential confounders, such as differences in environmental exposures, treatment selection, and histologic subtypes between men and women.


CONCLUSIONS
Our analysis identified female gender as a poor-risk feature for patients undergoing radical cystectomy. This adverse prognostic factor was independent of standard clinical and pathologic features and competing risk from non-cancer-related death.
Department of Urology, The University of Texas Health Science Center, San Antonio, TX.
Jamie C
JC
Messer
Department of Urology, Cornell University, New York City, NY.
Shahrokh F
SF
Shariat
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Colin P
CP
Dinney
University of Padua, Padua, Italy.
Giacomo
G
Novara
Laval University, Québec City, Québec, Canada.
Yves
Y
Fradet
Department of Urology, McGill University Health Centre, Montréal, Quebec, Canada.
Wassim
W
Kassouf
Department of Urology, University of Montréal, Montreal, Canada.
Pierre I
PI
Karakiewicz
Department of Urology, University of Regensburg, Regensburg, Germany.
Hans-Martin
HM
Fritsche
Departments of Surgery and Oncology, University of Western Ontario, London, Ontario, Canada.
Jonathan I
JI
Izawa
Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX.
Yair
Y
Lotan
Department of Urology, The University of Southern California, Los Angeles, CA.
Eila C
EC
Skinner
University Hospital Munich Grosshadern, Munich, Germany.
Derya
D
Tilki
University of Padua, Padua, Italy.
Vincenzo
V
Ficarra
Department of Urology, University of Ulm, Ulm, Germany.
Bjoern G
BG
Volkmer
Prostate Cancer Center Hamburg-Eppendorf, Martini-Clinic, Hamburg, Germany.
Hendrik
H
Isbarn
Department of Statistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
Caimiao
C
Wei
Scott Department of Urology, Baylor College of Medicine, Houston, TX.
Seth P
SP
Lerner
Department of Hematology/Oncology, The University of Texas Health Science Center, San Antonio, TX.
Tyler J
TJ
Curiel
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Ashish M
AM
Kamat
Department of Urology, The University of Texas Health Science Center, San Antonio, TX. Electronic address: svatek@uthscsa.edu.
Robert S
RS
Svatek
D002277:Carcinoma / Q000401:mortality / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*; D019459:Urothelium / Q000473:pathology* / Q000601:surgery*