Impact of gender on tumor stage and survival of upper urinary tract urothelial cancer : A population-based study.
BACKGROUND
The aim of this study was to analyze the impact of gender on tumor stage, overall and cancer-specific mortality of upper urinary tract urothelial cancer (UTUC) in a population-based, nationwide analysis.


METHODS
All Austrian patients with UTUC diagnosed between 1983 and 2010 were included in this study. Overall mortality was estimated by the Kaplan-Meier method. Cancer-specific (UTUC) mortality was estimated by cumulative incidence with mortality due to other causes as a competing risk. The effect of age was adjusted in a descriptive as well as a statistical inferential way.


RESULTS
This study included 2066 patients (men n = 1169, mean age 68.3 ±11.5 years, women n = 897, 72.6 ±10.4 years). Tumor stage distribution was as follows: pT1: men n = 411, women n = 268, pT2: men n = 263, women n = 187, pT3: men n = 382, women n = 328 and pT4: men n = 113, women n = 114. The male:female ratio continuously declined from 1.5 for pT1 tumors to 1.4 for pT2 tumors, 1.2 for pT3 tumors and 1.0 for pT4-tumors. In the entire cohort the 5‑year cumulative overall mortality was 57 % for women versus 50 % for men (p = 0.0002). For pT1 (women 33 %, men 31 %) and pT2 stage tumors (women 45 %, men 45 %) the 5‑year overall mortality was comparable between both sexes. In pT3 (women 68 %, men 62 %) and pT4 (women 95 %, men 87 %) tumors women had a higher overall mortality rate. The 5‑year cancer-specific mortality (CSM) of the entire cohort was 12 % for women and 10 % for men (p = 0.067): pT1 women 5 % men 3 %, pT2 women 9 % men 10 %, pT3 women 14 % men 11 % and pT4 women 29 % men 27 %.


CONCLUSIONS
In this population-based nationwide analysis, sex differences were notable for UTUC. Women tended to have more advanced tumor stages at diagnosis and a higher overall and cancer-specific mortality in advanced tumor stages.
Department of Urology, Kaiser-Franz-Josef-Spital, Vienna, Austria.|Department of Urology, Medical University of Graz, Graz, Austria.
Badereddin
B
Mohamad Al-Ali
Department of Urology, Kaiser-Franz-Josef-Spital, Vienna, Austria.
Stephan
S
Madersbacher
Austrian National Cancer Registry, Statistics Austria, Vienna, Austria.
Nadine
N
Zielonke
Department of Urology, Kaiser-Franz-Josef-Spital, Vienna, Austria.
Ingrid
I
Schauer
Department of Epidemiology, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria. thomas.waldhoer@meduniwien.ac.at.
Thomas
T
Waldhoer
Department of Epidemiology, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria.
Gerald
G
Haidinger
D017677:Age Distribution; D001317:Austria / Q000453:epidemiology; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009367:Neoplasm Staging; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D015996:Survival Rate; D014571:Urologic Neoplasms / Q000401:mortality* / Q000473:pathology*
Radical nephroureterectomy; Sex; Tumor stage; Upper urinary tract; Urothelial carcinoma
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