Associations Between Female Sex and Treatment Patterns and Outcomes for Muscle-invasive Bladder Cancer.

To investigate the association of female sex with the selected treatment for patients with nonmetastatic muscle-invasive bladder cancer. Sex is a known independent predictor of death from bladder cancer. A potential explanation for this survival disparity is difference in treatment pattern and stage presentation among males and females.

Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare data set, we identified 6,809 patients initially diagnosed with nonmetastatic muscle-invasive bladder cancer between 2004-2014. We fit multivariable logistic regression and Cox models to assess the relationship of sex with treatment modality and survival adjusting for differences in patient characteristics.

Of the 6,809 patients with nonmetastatic muscle invasive bladder cancer, 2,528 (37%) received a radical cystectomy while 4,281(63%) received an alternative bladder sparing intervention. Women were significantly more likely to receive a cystectomy (OR 1.39; 95% CI 1.20-1.61), present at an older age with less comorbidities compared to men (p <0.001). Women were also found to have worse bladder cancer-specific survival (CSS) than men (HR 1.18; 95% CI 1.05-1.32), no difference in overall survival (OS) (female HR 0.93; 0.86-1.01) and lower mortality from other causes (HR 0.78; 95% CI 0.70-0.86). There were no differences in OS and CSS by sex in patients with stage pT4a.

Female sex predicted more aggressive treatment with radical cystectomy yet worse cancer-specific survival than males. This sex disparity in CSS reduced the known OS advantage observed in women.

Urology. 2020 Jul 13 [Epub ahead of print]

Valentina Grajales, Jathin Bandari, Nathan E Hale, Jonathan G Yabes, Robert M Turner, Mina M Fam, Lindsay M Sabik, Jeffrey R Gingrich, Benjamin J Davies, Bruce L Jacobs

Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: ., Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Department of Urology, Charleston Area Medical Center, Charleston, WV, USA., Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Coastal Urology Associates, Hackensack Meridian Health, Brick, NJ, USA., Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA., Division of Urology, Department of Surgery, Duke University, Durham, NC, USA.