Mp22-05 Sex Differences in Muscle-Invasive Bladder Cancer With Radical Cystectomy

You have accessJournal of UrologyBladder Cancer: Invasive II (MP22)1 May 2024MP22-05 SEX DIFFERENCES IN MUSCLE-INVASIVE BLADDER CANCER WITH RADICAL CYSTECTOMY Kiera Liblik, Marlo Whitehead, and Robert Siemens Kiera LiblikKiera Liblik , Marlo WhiteheadMarlo Whitehead , and Robert SiemensRobert Siemens View All Author Informationhttps://doi.org/10.1097/01.JU.0001008608.50694.4b.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Emerging research in muscle-invasive bladder cancer (MIBC) suggests that female patients have delayed presentation, differential treatment response, less guideline-concordant care, and worse survival outcomes as compared to male patients. The actual degree of these differences and contributing factors are poorly understood due to a historical paucity of sex-based analysis. The present study analyzes sex differences in a large cohort of patients who underwent radical cystectomy (RC). METHODS: This is a retrospective, population-based study of all MIBC patients that underwent RC in Ontario, Canada between 2009-2013 utilizing records linked to the Ontario Cancer Registry. The primary objective was to assess sex differences in treatment variables and outcomes including downstaging, cancer-specific survival (CSS), and overall survival (OS). Cox proportional-hazards regression models were used to adjust for known confounders. RESULTS: In total, 1,573 patients were included (32.9% female) with no sex differences in baseline characteristics. The final pathological stage was higher in female than male patients (82% versus 77% ≥pT2). Perioperative management was similar between sexes, including wait times, chemotherapy use, and multi-disciplinary consultations. Although, female patients were less likely to undergo a pelvic lymph node dissection (PLND) than male patients (91% vs. 95%; p=0.007). The downstaging rate was also higher in male patients (10.8%) than in female patients (8.1%). Univariate analysis demonstrated a statistically non-significant female versus male differential in CSS (Hazard Ratio 1.17 (95% Confident Interval CI 0.99-1.37); p=0.06) and OS (HR 1.16 (95%CI 1.00-1.34); p=0.05). After adjusting for confounders, there was no difference in OS between female versus male patients (HR 1.07; p=0.33), including when only looking at T2+ patients (HR 1.16; p=0.09). CONCLUSIONS: This study represents an important addition to the literature on sex differences in MIBC patients undergoing RC in real-life practice. Although there were no sex differences in perioperative care, there were lower rates of PLND and pathological downstaging in female patients. Absolute survival differences were not appreciated; however, this did not adjust for a higher average life expectancy in female as compared to male Canadians. The results in this modest cohort suggest that the relative survival of female patients is inferior, warranting further investigation. These observations underscore the need to report bladder cancer outcomes by sex as opposed to only using sex as a model variable. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e342 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kiera Liblik More articles by this author Marlo Whitehead More articles by this author Robert Siemens More articles by this author Expand All Advertisement PDF downloadLoading ...