Impact of sex on response to neoadjuvant chemotherapy in patients with bladder cancer.

To assess the effect of patient's sex on response to neoadjuvant chemotherapy (NAC) in patients with clinically nonmetastatic muscle-invasive bladder cancer (MIBC).

Complete pathologic response, defined as ypT0N0 at radical cystectomy, and downstaging were evaluated using sex-adjusted univariable and multivariable logistic regression modeling. We used interaction terms to account for age of menopause and smoking status. The association of sex with overall survival and cancer-specific survival was evaluated using Cox regression analyses.

A total of 1,031 patients were included in the analysis, 227 (22%) of whom were female. Female patients had a higher rate of extravesical disease extension (P = 0.01). After the administration of NAC, ypT stage was equally distributed between sexes (P = 0.39). On multivariable logistic regression analyses, there was no difference between the sexes or age of menopause with regards to ypT0N0 rates or downstaging (all P > 0.5). On Cox regression analyses, sex was associated with neither overall survival (hazard ratio 1.04, 95% confidence interval 0.75-1.45, P = 0.81) nor cancer-specific survival (hazard ratio 1.06, 95% confidence interval 0.71-1.58, P = 0.77).

Our study generates the hypothesis that NAC equalizes the preoperative disparity in pathologic stage between males and females suggesting a possible differential response between sexes. This might be the explanation underlying the comparable survival outcomes between sexes despite females presenting with more advanced tumor stage.

Urologic oncology. 2020 Feb 11 [Epub ahead of print]

David D'Andrea, Peter C Black, Homayoun Zargar, Kamran Zargar-Shoshtari, Sonja Zehetmayer, Adrian S Fairey, Laura S Mertens, Colin P Dinney, Maria C Mir, Laura-Maria Krabbe, Michael S Cookson, Niels-Erik Jacobsen, Jeffrey S Montgomery, Nikhil Vasdev, Evan Y Yu, Evanguelos Xylinas, Nicholas J Campain, Wassim Kassouf, Marc A Dall'Era, Jo-An Seah, Cesar E Ercole, Simon Horenblas, Srikala S Sridhar, John S McGrath, Jonathan Aning, Jonathan L Wright, Andrew C Thorpe, Todd M Morgan, Jeffrey M Holzbeierlein, Trinity J Bivalacqua, Scott North, Daniel A Barocas, Yair Lotan, Petros Grivas, Andrew J Stephenson, Jay B Shah, Bas W van Rhijn, Siamak Daneshmand, Philippe E Spiess, Shahrokh F Shariat

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada., Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada; Western Health, Melbourne, Australia., Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Auckland, Auckland, New Zealand., Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria., University of Alberta, Edmonton, AB, Canada., Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, MD Anderson Cancer Center, Houston, TX., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, University of Münster, Münster, Germany., Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK., Department of Urology, University of Michigan Health System, Ann Arbor, MI., Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK; Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK., Department of Medicine, Division of Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA., Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France., Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK., Department of Surgery (Division of Urology), McGill University Health Center, Montreal, Canada., Department of Urology, University of California at Davis, Davis Medical Center, Sacramento, CA., Princess Margaret Hospital, Toronto, ON, Canada., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH., Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK., Department of Urology, University of Washington, Seattle, WA., Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK., Department of Urology, University of Kansas Medical Center, Kansas City, KS., Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD., Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, Edmonton, AB, Canada., Department of Urology, Vanderbilt University Medical Center, Nashville, TN., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX., Department of Medicine, Division of Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, , Cleveland, OH., Department of Urology, MD Anderson Cancer Center, Houston, TX; Department of Urology, Stanford University School of Medicine, Stanford, CA., USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA., Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Departments of Urology, Weill Cornell Medical College, New York, New York; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. Electronic address: .