Bladder Cancer Survival Worse Among Women Despite RC
Among stage 2 to 4 bladder cancer patients, women had lower cancer-specific survival than men.
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BOSTON — Female bladder cancer patients are at higher risk of overall and cancer-specific mortality risk than their male counterparts, but this gender disparity is not due to delayed radical cystectomy, investigators reported at the American Urological Association 2017 annual meeting.
A growing body of research shows that female patients have worse survival after a bladder cancer diagnosis. Recent studies have suggested that treatment disparities, such as an absence of RC, are the cause. For example, many patients diagnosed with non-muscle invasive or muscle-invasive bladder cancer that is refractory to medication still don't receive RC.
“We found that process of care determinants, such as radical cystectomy use and treatment delay, were not associated with gender differences in survival,” Stephen B. Williams, MD, Director of Urologic Research at the University of Texas Medical Branch at Galveston , told Renal & Urology News. “Gender differences persist with women significantly more likely to undergo radical cystectomy independent of clinical stage.”
Using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data, Dr Williams and colleagues examined RC receipt and timing among 49,974 patients older than 66 years diagnosed with clinical stage 1 to 4 bladder cancer from 2002 to 2011. Roughly three quarters of patients were male and one quarter female.
Although women were 53%, 52%, 26%, and 31% more likely than men to receive RC at clinical stage 1, 2, 3, and 4, respectively, they had a significant 20%, 44%, and 29% increased risk of bladder cancer-specific mortality at stage 2, 3, and 4, respectively. Overall survival results showed the same trend by gender.
Delayed surgery from the time of diagnosis was associated with worse survival, but men and women had similar risks of delayed surgery across clinical stages, with the exception of stage 4. Women with stage 4 disease actually were 23% less likely to have delayed surgery.
Female patients tended to have more advanced bladder cancer, so the investigators accounted for tumor characteristics, including clinical stage, tumor grade, as well as use of lymph node dissection and neoadjuvant chemotherapy. Women also carried a greater burden of co-existing illnesses and more were older and non-Caucasian. When the investigators adjusted for all of these clinical and patient characteristics, women still were more likely to die from bladder cancer.
The findings hint that biological differences in carcinogenesis may be the more likely basis of gender disparities.
Fang JE, Huo J, Kerr PS, et al. Survival differences among bladder cancer patients according to gender: Critical evaluation of radical cystectomy use and delay to treatment. [abstract]. J Urol 2017;197(4S):e33. Poster presented at the American Urological Association 2017 annual meeting on May 12, 2017. MP04-014.