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Associations Between Female Sex and Treatment Patterns and Outcomes for Muscle-invasive Bladder Cancer.
Valentina Grajales1, Jathin Bandari1, Nathan E Hale2
1Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Urology
|July 17, 2020
Summary
Female patients with muscle-invasive bladder cancer received more aggressive treatment but had worse survival. This finding highlights sex disparities in bladder cancer care and outcomes.
Area of Science:
- Urology
- Oncology
- Health Services Research
Background:
- Sex is an independent predictor of bladder cancer mortality.
- Survival disparities between males and females may stem from differences in treatment and disease presentation.
Purpose of the Study:
- To investigate the association between female sex and treatment selection in nonmetastatic muscle-invasive bladder cancer.
- To analyze how sex influences treatment patterns and survival outcomes in this patient population.
Main Methods:
- Analysis of the Surveillance, Epidemiology, and End Results-Medicare data set (2004-2014).
- Inclusion of 6809 patients diagnosed with nonmetastatic muscle-invasive bladder cancer.
- Multivariable logistic regression and Cox models were used to assess the relationship of sex with treatment and survival, adjusting for patient characteristics.
Main Results:
- Women were more likely to receive radical cystectomy (OR 1.39) compared to men.
- Women presented older, with fewer comorbidities, and had worse cancer-specific survival (HR 1.18).
- No difference in overall survival was observed, and women had lower mortality from other causes (HR 0.78).
Conclusions:
- Female sex is associated with more aggressive treatment (radical cystectomy) but worse cancer-specific survival in nonmetastatic muscle-invasive bladder cancer.
- The observed sex disparity in cancer-specific survival diminishes the overall survival advantage typically seen in women.
- No significant differences in overall or cancer-specific survival by sex were found in patients with stage pT4a disease.
