Female gender is associated with higher risk of disease recurrence in patients with primary T1 high-grade urothelial carcinoma of the bladder

Luis A. Kluth, Harun Fajkovic, Evanguelos Xylinas, Joseph J. Crivelli, Niccolo Passoni, Morgan Rouprêt, Andreas Becker, Evi Comploj, Armin Pycha, Sten Holmang, Amit Gupta, Yair Lotan, Pierre I. Karakiewicz, Paolo Gontero, Felix K H Chun, Margit Fisch, Douglas S. Scherr, Shahrokh F. Shariat

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Abstract

Purpose: An increasing body of evidence suggests gender differences in the presentation and prognosis of bladder cancer. We aimed to assess the impact of gender on outcomes in patients with primary T1 high-grade (HG) urothelial carcinoma of the bladder (UCB). Methods: We retrospectively analysed the data from 916 patients with primary T1HG UCB from 7 tertiary care centres. Patients were treated with transurethral resection of the bladder with or without intravesical instillation therapy (IVT). Univariable and multivariable Cox regression analyses assessed the effect of gender on outcomes. Results: Within a median follow-up of 42.8 months, 365 (39.8 %) patients experienced disease recurrence, 104 (11.4 %) progression, 59 (6.4 %) cancer-specific mortality and 190 (20.7 %) mortality of any cause. Overall, 634 (69.2 %) patients received IVT of which 234 (25.5 %) received BCG therapy. Female gender (n = 190, 20.7 %) was associated with higher risk of disease recurrence (HR:1.359;1.071-1.724, p = 0.012) in all patients and in a subgroup of patients treated with BCG therapy (HR:1.717;1.101-2.677, p = 0.017). There was no difference between genders with regard to disease progression, cancer-specific mortality and any-cause mortality. In multivariable analyses that adjusted for the effects of concomitant carcinoma in situ (CIS), tumour size, number of tumours, and IVT, gender remained an independent predictor for disease recurrence (p = 0.026) when analysed in all patients, but not in the subgroup of BCG treated patients (p = 0.093). Conclusions: In patients with T1HG UCB, female gender is associated with higher risk of disease recurrence, but not with disease progression. This gender disparity may be due to differences in care and/or biology of UCB.

Original languageEnglish (US)
Pages (from-to)1029-1036
Number of pages8
JournalWorld Journal of Urology
Volume31
Issue number5
DOIs
StatePublished - Oct 2013

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Urinary Bladder
Carcinoma
Recurrence
Intravesical Administration
Mycobacterium bovis
Mortality
Disease Progression
Neoplasms
Therapeutics
Carcinoma in Situ
Urinary Bladder Neoplasms
Tertiary Care Centers
Regression Analysis

Keywords

  • Bladder carcinoma
  • Disease recurrence
  • Gender
  • T1 urothelial cancer

ASJC Scopus subject areas

  • Urology

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Female gender is associated with higher risk of disease recurrence in patients with primary T1 high-grade urothelial carcinoma of the bladder. / Kluth, Luis A.; Fajkovic, Harun; Xylinas, Evanguelos; Crivelli, Joseph J.; Passoni, Niccolo; Rouprêt, Morgan; Becker, Andreas; Comploj, Evi; Pycha, Armin; Holmang, Sten; Gupta, Amit; Lotan, Yair; Karakiewicz, Pierre I.; Gontero, Paolo; Chun, Felix K H; Fisch, Margit; Scherr, Douglas S.; Shariat, Shahrokh F.

In: World Journal of Urology, Vol. 31, No. 5, 10.2013, p. 1029-1036.

Research output: Contribution to journalArticle

Kluth, LA, Fajkovic, H, Xylinas, E, Crivelli, JJ, Passoni, N, Rouprêt, M, Becker, A, Comploj, E, Pycha, A, Holmang, S, Gupta, A, Lotan, Y, Karakiewicz, PI, Gontero, P, Chun, FKH, Fisch, M, Scherr, DS & Shariat, SF 2013, 'Female gender is associated with higher risk of disease recurrence in patients with primary T1 high-grade urothelial carcinoma of the bladder', World Journal of Urology, vol. 31, no. 5, pp. 1029-1036. https://doi.org/10.1007/s00345-012-0996-9
Kluth, Luis A. ; Fajkovic, Harun ; Xylinas, Evanguelos ; Crivelli, Joseph J. ; Passoni, Niccolo ; Rouprêt, Morgan ; Becker, Andreas ; Comploj, Evi ; Pycha, Armin ; Holmang, Sten ; Gupta, Amit ; Lotan, Yair ; Karakiewicz, Pierre I. ; Gontero, Paolo ; Chun, Felix K H ; Fisch, Margit ; Scherr, Douglas S. ; Shariat, Shahrokh F. / Female gender is associated with higher risk of disease recurrence in patients with primary T1 high-grade urothelial carcinoma of the bladder. In: World Journal of Urology. 2013 ; Vol. 31, No. 5. pp. 1029-1036.
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abstract = "Purpose: An increasing body of evidence suggests gender differences in the presentation and prognosis of bladder cancer. We aimed to assess the impact of gender on outcomes in patients with primary T1 high-grade (HG) urothelial carcinoma of the bladder (UCB). Methods: We retrospectively analysed the data from 916 patients with primary T1HG UCB from 7 tertiary care centres. Patients were treated with transurethral resection of the bladder with or without intravesical instillation therapy (IVT). Univariable and multivariable Cox regression analyses assessed the effect of gender on outcomes. Results: Within a median follow-up of 42.8 months, 365 (39.8 {\%}) patients experienced disease recurrence, 104 (11.4 {\%}) progression, 59 (6.4 {\%}) cancer-specific mortality and 190 (20.7 {\%}) mortality of any cause. Overall, 634 (69.2 {\%}) patients received IVT of which 234 (25.5 {\%}) received BCG therapy. Female gender (n = 190, 20.7 {\%}) was associated with higher risk of disease recurrence (HR:1.359;1.071-1.724, p = 0.012) in all patients and in a subgroup of patients treated with BCG therapy (HR:1.717;1.101-2.677, p = 0.017). There was no difference between genders with regard to disease progression, cancer-specific mortality and any-cause mortality. In multivariable analyses that adjusted for the effects of concomitant carcinoma in situ (CIS), tumour size, number of tumours, and IVT, gender remained an independent predictor for disease recurrence (p = 0.026) when analysed in all patients, but not in the subgroup of BCG treated patients (p = 0.093). Conclusions: In patients with T1HG UCB, female gender is associated with higher risk of disease recurrence, but not with disease progression. This gender disparity may be due to differences in care and/or biology of UCB.",
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T1 - Female gender is associated with higher risk of disease recurrence in patients with primary T1 high-grade urothelial carcinoma of the bladder

AU - Kluth, Luis A.

AU - Fajkovic, Harun

AU - Xylinas, Evanguelos

AU - Crivelli, Joseph J.

AU - Passoni, Niccolo

AU - Rouprêt, Morgan

AU - Becker, Andreas

AU - Comploj, Evi

AU - Pycha, Armin

AU - Holmang, Sten

AU - Gupta, Amit

AU - Lotan, Yair

AU - Karakiewicz, Pierre I.

AU - Gontero, Paolo

AU - Chun, Felix K H

AU - Fisch, Margit

AU - Scherr, Douglas S.

AU - Shariat, Shahrokh F.

PY - 2013/10

Y1 - 2013/10

N2 - Purpose: An increasing body of evidence suggests gender differences in the presentation and prognosis of bladder cancer. We aimed to assess the impact of gender on outcomes in patients with primary T1 high-grade (HG) urothelial carcinoma of the bladder (UCB). Methods: We retrospectively analysed the data from 916 patients with primary T1HG UCB from 7 tertiary care centres. Patients were treated with transurethral resection of the bladder with or without intravesical instillation therapy (IVT). Univariable and multivariable Cox regression analyses assessed the effect of gender on outcomes. Results: Within a median follow-up of 42.8 months, 365 (39.8 %) patients experienced disease recurrence, 104 (11.4 %) progression, 59 (6.4 %) cancer-specific mortality and 190 (20.7 %) mortality of any cause. Overall, 634 (69.2 %) patients received IVT of which 234 (25.5 %) received BCG therapy. Female gender (n = 190, 20.7 %) was associated with higher risk of disease recurrence (HR:1.359;1.071-1.724, p = 0.012) in all patients and in a subgroup of patients treated with BCG therapy (HR:1.717;1.101-2.677, p = 0.017). There was no difference between genders with regard to disease progression, cancer-specific mortality and any-cause mortality. In multivariable analyses that adjusted for the effects of concomitant carcinoma in situ (CIS), tumour size, number of tumours, and IVT, gender remained an independent predictor for disease recurrence (p = 0.026) when analysed in all patients, but not in the subgroup of BCG treated patients (p = 0.093). Conclusions: In patients with T1HG UCB, female gender is associated with higher risk of disease recurrence, but not with disease progression. This gender disparity may be due to differences in care and/or biology of UCB.

AB - Purpose: An increasing body of evidence suggests gender differences in the presentation and prognosis of bladder cancer. We aimed to assess the impact of gender on outcomes in patients with primary T1 high-grade (HG) urothelial carcinoma of the bladder (UCB). Methods: We retrospectively analysed the data from 916 patients with primary T1HG UCB from 7 tertiary care centres. Patients were treated with transurethral resection of the bladder with or without intravesical instillation therapy (IVT). Univariable and multivariable Cox regression analyses assessed the effect of gender on outcomes. Results: Within a median follow-up of 42.8 months, 365 (39.8 %) patients experienced disease recurrence, 104 (11.4 %) progression, 59 (6.4 %) cancer-specific mortality and 190 (20.7 %) mortality of any cause. Overall, 634 (69.2 %) patients received IVT of which 234 (25.5 %) received BCG therapy. Female gender (n = 190, 20.7 %) was associated with higher risk of disease recurrence (HR:1.359;1.071-1.724, p = 0.012) in all patients and in a subgroup of patients treated with BCG therapy (HR:1.717;1.101-2.677, p = 0.017). There was no difference between genders with regard to disease progression, cancer-specific mortality and any-cause mortality. In multivariable analyses that adjusted for the effects of concomitant carcinoma in situ (CIS), tumour size, number of tumours, and IVT, gender remained an independent predictor for disease recurrence (p = 0.026) when analysed in all patients, but not in the subgroup of BCG treated patients (p = 0.093). Conclusions: In patients with T1HG UCB, female gender is associated with higher risk of disease recurrence, but not with disease progression. This gender disparity may be due to differences in care and/or biology of UCB.

KW - Bladder carcinoma

KW - Disease recurrence

KW - Gender

KW - T1 urothelial cancer

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