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Sex Differences in Urothelial Bladder Cancer Survival
Karolinska Inst, Sweden.
Karolinska Univ Hosp, Sweden.
Karolinska Inst, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
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2020 (English)In: Clinical Genitourinary Cancer, ISSN 1558-7673, E-ISSN 1938-0682, Vol. 18, no 1, p. 26-+Article in journal (Refereed) Published
Abstract [en]

It is well known that women with urinary bladder cancer have poorer prognosis than men. We had complete clinical and sociodemographic data on close to 40,000 bladder cancer patients. The female survival disadvantage was limited to locally advanced tumors and was not explained by tumor nor patient characteristics. This indicates different management of locally advanced bladder cancer in men and women. Background: While urinary bladder cancer is consistently more common in men worldwide, women have poorer prognosis. The aim of this study was to outline sex differences in prognostic factors and clinical management and to explore whether these can explain the poorer urinary bladder cancer outcome in women. Patients and Methods: We performed a population-based cohort study including all patients diagnosed with urothelial bladder cancer between 1997 and 2014 at age 18 to 89 who had data recorded in the Swedish Urinary Bladder Cancer Register (n = 36,344). Female-to-male odds ratios for clinical management parameters were estimated by logistic regression. To quantify sex differences in bladder cancer-specific survival, we estimated empirical survival proportions and mortality rates as well as applied flexible parametric models to estimate female-to-male hazard ratios and survival proportions over follow-up. Adjusted models included age, year, World Health Organization grade, stage, marital status, education, health care region, birth country, and comorbidity. Results: Except for an adverse stage distribution in women, we found no evidence of unequal clinical management. Among those diagnosed with bladder cancer, women had a higher bladder cancer mortality (adjusted hazard ratio, 1.15; 95% confidence interval, 1.08-1.23) driven by muscle-invasive tumors (adjusted hazard ratio, 1.24; 95% confidence interval, 1.14-1.34). The female survival disadvantage was confined to the first 2 years after diagnosis. Conclusion: The excess bladder cancer mortality in women is limited to those diagnosed with muscle-invasive tumors and cannot be explained by the examined clinicopathologic factors. Further investigations of sex differences in therapeutic procedures and outcomes, including complications, of muscle-invasive bladder cancer, must be performed. (C) 2019 Elsevier Inc. All rights reserved.

Place, publisher, year, edition, pages
CIG MEDIA GROUP, LP , 2020. Vol. 18, no 1, p. 26-+
Keywords [en]
Registries; Sex factors; Survival analysis; Sweden/epidemiology; Urinary bladder neoplasms/mortality
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:liu:diva-164046DOI: 10.1016/j.clgc.2019.10.020ISI: 000512298400011PubMedID: 31787542OAI: oai:DiVA.org:liu-164046DiVA, id: diva2:1411727
Note

Funding Agencies|Swedish Research Council for Health, Working Life and WelfareSwedish Research CouncilSwedish Research Council for Health Working Life & Welfare (Forte) [FORTE 2013-0138]; Swedish Cancer SocietySwedish Cancer Society [15-0804]

Available from: 2020-03-04 Created: 2020-03-04 Last updated: 2020-03-04

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Jahnson, Staffan
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Division of Surgery, Orthopedics and OncologyFaculty of Medicine and Health SciencesDepartment of Urology in Östergötland
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