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Female sex linked to poor survival outcomes after radical cystectomy for bladder cancer

19 Mar 2018

Women who undergo radical cystectomy for bladder cancer are more likely to have worse outcomes, including disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS), compared with their male counterparts, a study reports.

Researchers conducted a systematic review and meta-analysis of studies evaluating gender-specific differences in DFS, CSS or OS following radical cystectomy in bladder cancer patients. Random effect meta-analysis, subgroup analyses, meta-influence and cumulative meta-analyses were used. Funnel plot and Egger´s test facilitated assessment of publication bias.

A total of 3,868 studies were identified during literature search, of which 59 were included in the analysis. There were 30 studies (n=38,321) that evaluated DFS, 44 studies (n=69,666) that evaluated CSS and 26 studies (n=30,039) that evaluated OS.

Pooled data revealed that DFS, CSS and OS were less favourable in female vs male patients, with respective hazard ratios of 1.16 (95 percent CI, 1.06–1.27; p=0.0018), 1.23 (1.15–1.31; p<0.001) and 1.08 (1.03–1.12; p=0.0004). Subgroup analyses confirmed worse DFS, CSS and OS in female patients in all strata.

Studies evaluating CSS showed publication bias (Egger´s test, p=0.0029). Correcting for publication bias via the trim and fill method yielded a corrected pooled HR estimate for CSS of 1.13 (1.05–1.21; p=0.0012).

The present data demonstrate gender-specific differences in DFS, CSS and OS following radical cystectomy in bladder cancer patients. Researchers pointed out that such difference might be explained by a multifactorial aetiology that included epidemiological differences, gender-specific healthcare discrepancies and hormonal influences.

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