The association between gender, stage and prognosis in bladder cancer patients undergoing radical cystectomy

The incidence of bladder cancer is three times as high in men compared to women. Moreover, women are generally diagnosed with a more severe tumor stage and have poorer prognosis. This study aimed to examine the association between gender, stage, and prognosis among a subgroup of bladder cancer patients treated with radical cystectomy.

A total of 460 patients (131 women, 329 men) with bladder cancer undergoing radical cystectomy at Aarhus University Hospital in 2015-2018 were retrospectively selected for this study and followed until 2021 at the latest. Correlations between gender, patient and tumor characteristics and oncological outcomes were analyzed by the Chi-squared test. By the use of multiple linear regression, we adjusted for age, comorbidity and the proportion of organ-confined and non-organ-confined disease at diagnosis.

Female patients were found to be younger and less comorbid than male patients. A higher proportion of patients with muscle-invasive bladder cancer and non-organ-confined disease at the time of cystectomy was observed among female patients. Recurrence of cancer occurred 3.4 (0.1-6.7) months earlier in female patients, and they had a 47% higher cancer-specific mortality (RR = 1.47 (1.04-2.1)) compared to male patients. In the adjusted analysis, the association of an earlier recurrence in female patients remained.

This study verifies that gender disparities exist among bladder cancer patients, even after adjusting for age, comorbidity and for the proportion of organ-confined and non-organ-confined disease at cystectomy. Further investigations are required to investigate the etiology of this observed difference between sexes.