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Analysis of sex differences in cancer-specific survival and perioperative mortality following radical cystectomy

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Analysis of sex differences in cancer-specific survival and perioperative mortality following radical cystectomy : results of a large German multicenter study of nearly 2500 patients with urothelial carcinoma of the bladder. / Otto, Wolfgang; May, Matthias; Fritsche, Hans-Martin; Dragun, Duska; Aziz, Atiqullah; Gierth, Michael; Trojan, Lutz; Herrmann, Edwin; Moritz, Rudolf; Ellinger, Jörg; Tilki, Derya; Buchner, Alexander; Höfner, Thomas; Brookman-May, Sabine; Nuhn, Philipp; Gilfrich, Christian; Roigas, Jan; Zacharias, Mario; Denzinger, Stefan; Hohenfellner, Markus; Haferkamp, Axel; Müller, Stefan C; Kocot, Arkadius; Riedmiller, Hubertus; Wieland, Wolf F; Stief, Christian G; Bastian, Patrick J; Burger, Maximilian.

In: GENDER MED, Vol. 9, No. 6, 01.12.2012, p. 481-9.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Otto, W, May, M, Fritsche, H-M, Dragun, D, Aziz, A, Gierth, M, Trojan, L, Herrmann, E, Moritz, R, Ellinger, J, Tilki, D, Buchner, A, Höfner, T, Brookman-May, S, Nuhn, P, Gilfrich, C, Roigas, J, Zacharias, M, Denzinger, S, Hohenfellner, M, Haferkamp, A, Müller, SC, Kocot, A, Riedmiller, H, Wieland, WF, Stief, CG, Bastian, PJ & Burger, M 2012, 'Analysis of sex differences in cancer-specific survival and perioperative mortality following radical cystectomy: results of a large German multicenter study of nearly 2500 patients with urothelial carcinoma of the bladder', GENDER MED, vol. 9, no. 6, pp. 481-9. https://doi.org/10.1016/j.genm.2012.11.001

APA

Otto, W., May, M., Fritsche, H-M., Dragun, D., Aziz, A., Gierth, M., Trojan, L., Herrmann, E., Moritz, R., Ellinger, J., Tilki, D., Buchner, A., Höfner, T., Brookman-May, S., Nuhn, P., Gilfrich, C., Roigas, J., Zacharias, M., Denzinger, S., ... Burger, M. (2012). Analysis of sex differences in cancer-specific survival and perioperative mortality following radical cystectomy: results of a large German multicenter study of nearly 2500 patients with urothelial carcinoma of the bladder. GENDER MED, 9(6), 481-9. https://doi.org/10.1016/j.genm.2012.11.001

Vancouver

Otto W, May M, Fritsche H-M, Dragun D, Aziz A, Gierth M et al. Analysis of sex differences in cancer-specific survival and perioperative mortality following radical cystectomy: results of a large German multicenter study of nearly 2500 patients with urothelial carcinoma of the bladder. GENDER MED. 2012 Dec 1;9(6):481-9. https://doi.org/10.1016/j.genm.2012.11.001

Bibtex

@article{df3027d7c5ef476c8442c891f6cc9601,
title = "Analysis of sex differences in cancer-specific survival and perioperative mortality following radical cystectomy: results of a large German multicenter study of nearly 2500 patients with urothelial carcinoma of the bladder",
abstract = "BACKGROUND: Outcome of patients with urothelial carcinoma of the bladder (UCB) varies between sexes. Although overall incidence is higher in men, cancer-specific survival (CSS) has been suggested to be lower in women. Although the former effect is attributed to greater exposure to carcinogens in men, the latter has not been elucidated.OBJECTIVES: The aim of the study was to identify sex-specific outcomes based on one of the largest databases of patients with UCB who underwent radical cystectomy (RC).METHODS: This retrospective multicenter series comprised 2483 patients in Stage M0 who underwent RC for UCB from 1989 to 2008; 20.4% of patients were women. The impact of sex on CSS in the entire study group and in specific subgroups was analyzed. The median follow-up time was 42 months (interquartile range, 21-79).RESULTS: Histopathologic criteria of pathologic tumor (pT), pathologic nodal (pN), grade, lymphovascular invasion (LVI), and associated carcinoma in situ (CIS) of the study did not differ between sexes. The percentage of female patients increased over time. Five-year CSS in female patients was significantly lower than in male patients (60% vs 66%; P = 0.005). In multivariate analysis adjusted to other covariates, tumor stage ≥pT3 (hazard ratio [HR] = 2.44; P < 0.001), positive pN status (HR = 1.91; P < 0.001), LVI (HR = 1.48; P < 0.001), lower count of lymph nodes removed (HR = 0.98; P = 0.002), older age (HR = 1.01; P < 0.001), and female gender (HR = 1.26; P = 0.011) had an independent impact on CSS. Deterioration of CSS in female patients was pronounced when LVI was present (HR = 1.57; P < 0.001) and when RC was performed in the earlier time period (HR = 2.44; P < 0.001). However, women showed significantly lower perioperative mortality (within 90 days after RC) compared with men.CONCLUSIONS: After RC for UCB, cancer-specific mortality was higher in female patients; this disadvantage was more pronounced in earlier time periods. In addition, worse outcome of women with verified LVI was shown to be comparable with men. These findings were suggestive of different tumor biology and potentially unequal access to timely RC in earlier time periods because of reduced awareness of UCB in women. Further studies are required to improve UCB outcome in both sexes, notably in female patients.",
keywords = "Age Factors, Aged, Blood Vessels, Carcinoma, Cystectomy, Female, Germany, Humans, Kaplan-Meier Estimate, Lymphatic Metastasis, Lymphatic Vessels, Male, Middle Aged, Multivariate Analysis, Neoplasm Invasiveness, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, Sex Factors, Survival Rate, Urinary Bladder Neoplasms",
author = "Wolfgang Otto and Matthias May and Hans-Martin Fritsche and Duska Dragun and Atiqullah Aziz and Michael Gierth and Lutz Trojan and Edwin Herrmann and Rudolf Moritz and J{\"o}rg Ellinger and Derya Tilki and Alexander Buchner and Thomas H{\"o}fner and Sabine Brookman-May and Philipp Nuhn and Christian Gilfrich and Jan Roigas and Mario Zacharias and Stefan Denzinger and Markus Hohenfellner and Axel Haferkamp and M{\"u}ller, {Stefan C} and Arkadius Kocot and Hubertus Riedmiller and Wieland, {Wolf F} and Stief, {Christian G} and Bastian, {Patrick J} and Maximilian Burger",
note = "Copyright {\textcopyright} 2012 Elsevier HS Journals, Inc. All rights reserved.",
year = "2012",
month = dec,
day = "1",
doi = "10.1016/j.genm.2012.11.001",
language = "English",
volume = "9",
pages = "481--9",
journal = "GENDER MED",
issn = "1550-8579",
publisher = "Excerpta Medica",
number = "6",

}

RIS

TY - JOUR

T1 - Analysis of sex differences in cancer-specific survival and perioperative mortality following radical cystectomy

T2 - results of a large German multicenter study of nearly 2500 patients with urothelial carcinoma of the bladder

AU - Otto, Wolfgang

AU - May, Matthias

AU - Fritsche, Hans-Martin

AU - Dragun, Duska

AU - Aziz, Atiqullah

AU - Gierth, Michael

AU - Trojan, Lutz

AU - Herrmann, Edwin

AU - Moritz, Rudolf

AU - Ellinger, Jörg

AU - Tilki, Derya

AU - Buchner, Alexander

AU - Höfner, Thomas

AU - Brookman-May, Sabine

AU - Nuhn, Philipp

AU - Gilfrich, Christian

AU - Roigas, Jan

AU - Zacharias, Mario

AU - Denzinger, Stefan

AU - Hohenfellner, Markus

AU - Haferkamp, Axel

AU - Müller, Stefan C

AU - Kocot, Arkadius

AU - Riedmiller, Hubertus

AU - Wieland, Wolf F

AU - Stief, Christian G

AU - Bastian, Patrick J

AU - Burger, Maximilian

N1 - Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

PY - 2012/12/1

Y1 - 2012/12/1

N2 - BACKGROUND: Outcome of patients with urothelial carcinoma of the bladder (UCB) varies between sexes. Although overall incidence is higher in men, cancer-specific survival (CSS) has been suggested to be lower in women. Although the former effect is attributed to greater exposure to carcinogens in men, the latter has not been elucidated.OBJECTIVES: The aim of the study was to identify sex-specific outcomes based on one of the largest databases of patients with UCB who underwent radical cystectomy (RC).METHODS: This retrospective multicenter series comprised 2483 patients in Stage M0 who underwent RC for UCB from 1989 to 2008; 20.4% of patients were women. The impact of sex on CSS in the entire study group and in specific subgroups was analyzed. The median follow-up time was 42 months (interquartile range, 21-79).RESULTS: Histopathologic criteria of pathologic tumor (pT), pathologic nodal (pN), grade, lymphovascular invasion (LVI), and associated carcinoma in situ (CIS) of the study did not differ between sexes. The percentage of female patients increased over time. Five-year CSS in female patients was significantly lower than in male patients (60% vs 66%; P = 0.005). In multivariate analysis adjusted to other covariates, tumor stage ≥pT3 (hazard ratio [HR] = 2.44; P < 0.001), positive pN status (HR = 1.91; P < 0.001), LVI (HR = 1.48; P < 0.001), lower count of lymph nodes removed (HR = 0.98; P = 0.002), older age (HR = 1.01; P < 0.001), and female gender (HR = 1.26; P = 0.011) had an independent impact on CSS. Deterioration of CSS in female patients was pronounced when LVI was present (HR = 1.57; P < 0.001) and when RC was performed in the earlier time period (HR = 2.44; P < 0.001). However, women showed significantly lower perioperative mortality (within 90 days after RC) compared with men.CONCLUSIONS: After RC for UCB, cancer-specific mortality was higher in female patients; this disadvantage was more pronounced in earlier time periods. In addition, worse outcome of women with verified LVI was shown to be comparable with men. These findings were suggestive of different tumor biology and potentially unequal access to timely RC in earlier time periods because of reduced awareness of UCB in women. Further studies are required to improve UCB outcome in both sexes, notably in female patients.

AB - BACKGROUND: Outcome of patients with urothelial carcinoma of the bladder (UCB) varies between sexes. Although overall incidence is higher in men, cancer-specific survival (CSS) has been suggested to be lower in women. Although the former effect is attributed to greater exposure to carcinogens in men, the latter has not been elucidated.OBJECTIVES: The aim of the study was to identify sex-specific outcomes based on one of the largest databases of patients with UCB who underwent radical cystectomy (RC).METHODS: This retrospective multicenter series comprised 2483 patients in Stage M0 who underwent RC for UCB from 1989 to 2008; 20.4% of patients were women. The impact of sex on CSS in the entire study group and in specific subgroups was analyzed. The median follow-up time was 42 months (interquartile range, 21-79).RESULTS: Histopathologic criteria of pathologic tumor (pT), pathologic nodal (pN), grade, lymphovascular invasion (LVI), and associated carcinoma in situ (CIS) of the study did not differ between sexes. The percentage of female patients increased over time. Five-year CSS in female patients was significantly lower than in male patients (60% vs 66%; P = 0.005). In multivariate analysis adjusted to other covariates, tumor stage ≥pT3 (hazard ratio [HR] = 2.44; P < 0.001), positive pN status (HR = 1.91; P < 0.001), LVI (HR = 1.48; P < 0.001), lower count of lymph nodes removed (HR = 0.98; P = 0.002), older age (HR = 1.01; P < 0.001), and female gender (HR = 1.26; P = 0.011) had an independent impact on CSS. Deterioration of CSS in female patients was pronounced when LVI was present (HR = 1.57; P < 0.001) and when RC was performed in the earlier time period (HR = 2.44; P < 0.001). However, women showed significantly lower perioperative mortality (within 90 days after RC) compared with men.CONCLUSIONS: After RC for UCB, cancer-specific mortality was higher in female patients; this disadvantage was more pronounced in earlier time periods. In addition, worse outcome of women with verified LVI was shown to be comparable with men. These findings were suggestive of different tumor biology and potentially unequal access to timely RC in earlier time periods because of reduced awareness of UCB in women. Further studies are required to improve UCB outcome in both sexes, notably in female patients.

KW - Age Factors

KW - Aged

KW - Blood Vessels

KW - Carcinoma

KW - Cystectomy

KW - Female

KW - Germany

KW - Humans

KW - Kaplan-Meier Estimate

KW - Lymphatic Metastasis

KW - Lymphatic Vessels

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Neoplasm Invasiveness

KW - Neoplasm Staging

KW - Proportional Hazards Models

KW - Retrospective Studies

KW - Sex Factors

KW - Survival Rate

KW - Urinary Bladder Neoplasms

U2 - 10.1016/j.genm.2012.11.001

DO - 10.1016/j.genm.2012.11.001

M3 - SCORING: Journal article

C2 - 23217567

VL - 9

SP - 481

EP - 489

JO - GENDER MED

JF - GENDER MED

SN - 1550-8579

IS - 6

ER -