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