Sex Remains Negative Prognostic Factor in Contemporary Cohort of High-Risk Non-Muscle-Invasive Bladder Cancer.

Sex-specific differences in outcomes of patients diagnosed with high-risk non-muscle-invasive bladder cancer (HR-NMIBC) have been reported with controversial findings. This study aims to investigate sex-specific diversities in the treatment and oncologic outcomes of primary HR-NMIBC in a multicenter setting. A multicenter retrospective analysis of 519 patients (388 men and 131 women) treated with transurethral resection (TUR) for primary HR-NMIBC was performed. Univariable and multivariable Cox regression models were used to investigate the association of clinico-pathologic features and generate hazard ratios (HRs). Second-look TUR (reTUR) was performed in 406 (78%) patients. A total of 218 (42%) of patients were subjected to an induction course of intravesical BCG (Bacillus Calmette-Guérin) plus maintenance therapy. The median follow-up was 44 months. Among the entire cohort, 238 (46%) and 86 patients (17%) had recurred and progressed to muscle-invasive disease (MIBC), respectively. Female sex was associated with increased risk of disease recurrence in the entire cohort: HR = 1.94, 95% CI = 1.48-2.55, p < 0.001 and HR = 1.91, 95% CI = 1.39-2.60, p < 0.001 in univariate and multivariate analysis, respectively. In patients subjected to reTUR and treated additionally with BCG, female sex was associated with increased risk of disease recurrence in univariate analysis (HR 1.81, 95% CI 1.07-3.06, p = 0.03), but not in multivariate analysis (HR 1.99, 95% CI 0.98-4.02, p = 0.06). There was no difference between sexes with regard to disease progression. HR-NMIBC diagnosed in females is associated with higher risk of disease recurrence when compared to males.

Cancers. 2022 Dec 12*** epublish ***

Konrad Bilski, Mieszko Kozikowski, MichaƂ A Skrzypczyk, Aleksandra Dobruch, Kees Hendricksen, David D'Andrea, Anna Katarzyna Czech, Jakub Dobruch

Department of Urology, Centre of Postgraduate Medical Education, Independent Public Hospital of Professor W. Orlowski, 00-416 Warsaw, Poland., Polish Center of Advanced Urology, Department of Urology, St. Anne's Hospital EMC, 05-500 Piaseczno, Poland., Sapienza University of Rome, 00185 Rome, Italy., Department of Urology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria., Department of Urology, Jagiellonian University Medical College, 31-008 Cracow, Poland.