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Is there also a gender difference in the prognosis of "evidence-based medicine" urothelial carcinoma?

 Last Update: 2022-11-01
 Source: Internet
 Author: User

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Guide

Bladderurothelial carcinoma (UCB) is the ninth most common cancer in the world, with approximately 75%-85% presenting as non-muscle-invasive bladder cancer (NMIBC).

About half of patients may relapse after treatment, and about 20% progress to muscle-invasive bladder cancer (MIBC).

Risk stratification of patients based on the probability of relapse and disease progression is key
to developing appropriate management strategies.
Recently, foreign researchers have evaluated the prognostic value of gender factors in NMIBC/MIBC patients after radical cystectomy (RC) treatment, and Yimaitong has compiled the relevant results as follows for readers
.

Research background

RC with lymph node dissection is the standard of care for high-risk NMIBC and MIBC, but patients still have poor 5-year overall survival (OS) (<60%)<b10>.
Therefore, there is a need to improve the risk stratification of UCB patients to help doctors make clinical decisions
.
The effect of sex differences in UCB has been extensively studied, but there has been no meta-analysis
of sex stratification comparisons of MIBC and NMIBC.
In addition, gender differences in UCB outcomes are often overlooked
in clinical practice.
Therefore, the investigators summarized the available data to determine whether sex differences predict the prognosis
of patients with NMIBC and MIBC.

Research methods

The investigators searched the PubMed, Web of Science, and Scopus databases and considered studies eligible if they involved comparisons of overall survival (OS), tumor-specific survival (CSS), disease progression, and recurrence-free survival in NMIBC/MIBC patients
.
The investigators performed a meta-analysis
of gender stratification of these results.

Research results

The investigators analysed
the results of 31 studies involving NMIBC (32,525 patients, 77.
8% male and 22.
2% female) and 63 studies involving MIBC (85,132 patients, 77.
5% male and 22.
5% female) included in this meta-analysis.

The study found that sex differences were significantly associated with CSS in MIBC patients, with women having worse CSS (Figure 1, pooled HR 1.
21; 95% CI 1.
11-1.
31), Cochrane's Q-test (P<0.
001) and<b10>I2 test (^I2=65%) indicating a high degree of heterogeneity
.
Similarly, sex differences were significantly associated with worse OS outcomes in women with MIBC, with a pooled HR of 1.
02 (95% CI 1.
00 to 1.
05).

Figure 1 Correlation analysis between gender and CSS in MIBC

Fig.
2 Correlation analysis between gender and OS in MIBC

In contrast, in patients with MIBC, sex differences were not significantly associated
with CSS (pooled HR 1.
01; 95% CI 0.
70 to 1.
46), progression-free survival (pooled HR 1.
04; 95% CI 0.
88 to 1.
24), and recurrence-free survival (pooled HR 1.
06; 95% CI 0.
98 to 1.
16).

conclusion

Studies have confirmed that female MIBC patients have a poor prognosis after undergoing radical surgery; In NMIBC, gender is independent of patient prognosis and warrants further research to verify
.
At the same time, doctors can take patient gender into account
when making clinical decisions.

References

Mori K, Yanagisawa T, Katayama S, Laukhtina E, Pradere B, Mostafaei H, Quhal F, Rajwa P, Moschini M, Soria F, D'andrea D, Abufaraj M, Albisinni S, Krajewski W, Fukuokaya W, Miki J, Kimura T, Egawa S, Teoh JY, Shariat SF; European Association of Urology–Young Academic Urologists Urothelial Carcinoma Working Group (EAU-YAU).
Impact of sex on outcomes after surgery for non-muscle-invasive and muscle-invasive bladder urothelial carcinoma: a systematic review and meta-analysis.
World J Urol.
2022 Aug 13.

Edit: LR

Review: LR

Execution: Wang Mumu

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