[Gender-specific differences in outcome and survival in early cystectomy : Systematic review]

Despite a lower incidence, women with bladder cancer have poorer survival rates than men. However, studies to date have provided insufficient data on gender-specific treatment outcomes, particularly after radical early cystectomy for Bacillus Calmette-Guérin (BCG) failure.

Are there gender-specific differences in oncologic outcomes and complication rates after radical early cystectomy in patients with nonmuscle invasive bladder cancer after failure of BCG instillation therapy?

A systematic literature search was conducted in MEDLINE and the Cochrane Library in January 2025. The complete study protocol has been prospectively registered at PROSPERO (ID CRD42024611111).

Three retrospective cohort studies with a total of 655 patients (18.8% of whom were women) were included. There were no significant gender-specific differences in terms of overall survival, cancer-specific survival, or progression. Data on complications and quality of life were limited or not available. In two studies, prostatic urethral involvement was identified as a negative prognostic marker in men.

The current evidence base is sparse, methodologically limited, and biased by the underrepresentation of women. Therefore, it is not possible to make reliable statements on the effect of gender on the efficacy of early cystectomy after BCG failure. Further research on gender-dependent risk factors, especially hormonal and immunological influences, is urgently needed to develop personalized treatment strategies.