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Berardi R, Rossi F, Papa R, Appetecchia M, Baggio G, Bianchini M, Mazzei T, Maria Moretti A, Ortona E, Pietrantonio F, Tarantino V, Vavalà T, Cinieri S. Gender oncology: recommendations and consensus of the Italian Association of Medical Oncology (AIOM). ESMO Open 2024; 9:102243. [PMID: 38394984 PMCID: PMC10937209 DOI: 10.1016/j.esmoop.2024.102243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/29/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Following the development of gender medicine in the past 20 years, more recently in the field of oncology an increasing amount of evidence suggests gender differences in the epidemiology of cancers, as well as in the response and toxicity associated with therapies. In a gender approach, critical issues related to sexual and gender minority (SGM) populations must also be considered. MATERIALS AND METHODS A working group of opinion leaders approved by the Italian Association of Medical Oncology (AIOM) has been set up with the aim of drafting a shared document on gender oncology. Through the 'consensus conference' method of the RAND/University of California Los Angeles (UCLA) variant, the members of the group evaluated statements partly from the scientific literature and partly produced by the experts themselves [good practice points (GPPs)], on the following topics: (i) Healthcare organisation, (ii) Therapy, (iii) Host factors, (iv) Cancer biology, and (v) Communication and social interventions. Finally, in support of each specific topic, they considered it appropriate to present some successful case studies. RESULTS A total of 42 articles met the inclusion criteria, from which 50 recommendations were extracted. Panel participants were given the opportunity to propose additional evidence from studies not included in the research results, from which 32 statements were extracted, and to make recommendations not derived from literature such as GPPs, four of which have been developed. After an evaluation of relevance by the panel, it was found that 81 recommendations scored >7, while 3 scored between 4 and 6.9, and 2 scored below 4. CONCLUSIONS This consensus and the document compiled thereafter represent an attempt to evaluate the available scientific evidence on the theme of gender oncology and to suggest standard criteria both for scientific research and for the care of patients in clinical practice that should take gender into account.
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Affiliation(s)
- R Berardi
- Medical Oncology, Polytechnic University of Marche Region, Ancona; Medical Oncology, AOU Marche, Ancona, Italy - National Councilor AIOM (Italian Association of Medical Oncology); Treasurer AIOM (Italian Association of Medical Oncology).
| | - F Rossi
- Medical Oncology, Polytechnic University of Marche Region, Ancona
| | - R Papa
- Quality, Risk Management and Health Technology Innovation Unit, Department of Staff, AOU Marche, Ancona
| | - M Appetecchia
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome
| | - G Baggio
- President of the Italian Research Center for Gender Health and Medicine, Chair of Gender Medicine 2012-2017, University of Padua, Padua
| | - M Bianchini
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome
| | - T Mazzei
- Department of Pharmacology, University of Florence, Florence
| | - A Maria Moretti
- National President of the Scientific Society GISeG (Italian Group Health and Gender); President of the International Society IGM (International Gender Medicine)
| | - E Ortona
- Head - Center for Gender-specific Medicine, Italian National Institute of Health, Rome
| | - F Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - V Tarantino
- Medical Oncology, Polytechnic University of Marche Region, Ancona
| | - T Vavalà
- SC of Oncology 1U, Department of Oncology, AOU Città della Salute e della Scienza, Torino; AIOM (Italian Association of Medical Oncology); GISeG (Italian Group Health and Gender)
| | - S Cinieri
- Medical Oncology and Breast Unit, Perrino Hospital, Brindisi; President of AIOM Foundation (Italian Association of Medical Oncology), Italy
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Song Y, Qin C, Zhang C, Peng Y, Yang W, Du Y, Xu T. GNRH family genes contributed to gender-specific disparity of bladder cancer prognosis through exerting opposite regulatory roles between males and females. J Cancer Res Clin Oncol 2023; 149:6827-6840. [PMID: 36806614 DOI: 10.1007/s00432-023-04640-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/07/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE There is gender-specific disparity in bladder cancer (BlCa) prognosis. Female BlCa patients present with more advanced tumor and have higher risks of disease recurrence, progression, and mortality than males. Since gonadotropin-releasing hormone (GNRH) family genes were critical genes in gender-related biological activity and could be detected in BlCa specimens, this study aimed to explore potential roles of GNRH1 and GNRHR in gender disparity of BlCa. METHODS RNA-sequencing data from The Cancer Genome Atlas Bladder Urothelial Carcinoma dataset, IMvigor210 immunotherapy cohort and Cancer Cell Line Encyclopedia database were used to compare potential roles of GNRH1 and GNRHR in males and females, respectively. Gene set enrichment analysis was used to analyze the biological functions. RESULTS Males with higher GNRH1 and GNRHR have better overall survival (P < 0.05, HR < 1), while females with higher expression have a trend toward worse overall survival (P < 0.05, HR > 1). Gene set enrichment analysis identified GNRH1 and GNRHR exert opposite regulatory roles in myogenesis (M5909), interferon-α response (M5911), interferon-γ response (M5913), inflammatory response (M5932) and TNF-α signaling via NF-κβ (M5890) between males and females. The five functions are up-regulated in females (NES > 0), while down-regulated in males (NES < 0). GNRH1 in females was positively correlated with CD3D (R-value > 0 and P < 0.05), while GNRHR in males was negatively correlated with CD247, CD3D and CD3E (R-value < 0 and P < 0.05). CONCLUSION GNRH1 and GNRHR have opposite effects on overall survival in different genders, and exert opposite roles in immune-related functions between different genders, which could emerge as a contributor to gender disparity of BlCa prognosis.
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Affiliation(s)
- Yuxuan Song
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Caipeng Qin
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Chunlong Zhang
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Yun Peng
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Wenbo Yang
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Yiqing Du
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China.
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China.
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He Y, Su Y, Zeng J, Chong W, Hu X, Zhang Y, Peng X. Cancer-specific survival after diagnosis in men versus women: A pan-cancer analysis. MedComm (Beijing) 2022; 3:e145. [PMID: 35783087 PMCID: PMC9246337 DOI: 10.1002/mco2.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 02/05/2023] Open
Abstract
Comprehensive understanding of cancer‐specific survival differences in gender is critical for cancer prevention and treatment. Based on the Surveillance Epidemiology and End Results database, we included data from the most prevalent cancers (lung, esophageal, liver, pancreatic, stomach, colorectal, kidney, and bladder cancer). Cox proportional hazards regression models were constructed to estimate hazard ratios, simultaneously adjusting for demographic, clinical, and treatment factors. Overall, male patients had a worse cancer‐specific survival than female patients. After adjustment for cancer prevalence with 1:1 matching, gender remained a significant factor in cancer‐specific survival. Among the included cancer types, female patients showed survival benefit in lung, liver, colorectal, pancreatic, stomach, and esophageal cancer, and male patients showed better survival in bladder cancer. Except for kidney cancer, the gender disparity was consistent between cancer patients with nonmetastatic and metastatic disease. Overall, gender appears to be a significant factor influencing cancer‐specific survival, and the prognosis of female patients is better than male patients in most cancers. This work might inspire the development of strategies for gender‐specific precision cancer prevention and treatment.
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Affiliation(s)
- Yan He
- Department of Biotherapy, West China Hospital Sichuan University Chengdu China
| | - Yonglin Su
- Department of Rehabilitation West China Hospital Sichuan University Chengdu China
| | - Junsong Zeng
- Department of Biotherapy, West China Hospital Sichuan University Chengdu China
| | - Weelic Chong
- Department of Medical Oncology Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Xiaolin Hu
- Department of Nursing, West China Hospital Sichuan University Chengdu China
| | - Yu Zhang
- Affiliated Hospital of Chengdu University Chengdu China
| | - Xingchen Peng
- Department of Biotherapy, West China Hospital Sichuan University Chengdu China
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Becattini L, Saieva C, Doni L, Roviello G, Spatafora P, Catalano M, Sessa F, Galli IC, Bisegna C, Conte FL, Zaccaro C, Santi R, Serni S, Nesi G, Villari D. Gender and Advanced Urothelial Cancer: Outcome, Efficacy and Toxicity following Chemotherapy. Medicina (B Aires) 2022; 58:886. [PMID: 35888605 PMCID: PMC9318271 DOI: 10.3390/medicina58070886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Objectives: The incidence of urothelial cancer in males is higher than in females; however, females have a higher risk of recurrence and progression. The aim of our study was to report the effect of gender on the oncological outcome in advanced urothelial cancer. Materials and Methods: In our retrospective study, all patients had undergone primary surgical treatment for urothelial cancer and were affected by stage IV disease at the time of chemotherapy. Response to therapy and toxicity were evaluated. Subgroups were analyzed for tumour presentation, first- and second-line treatment response, progression-free survival (PFS) and overall survival (OS). Results. Seventy-five patients, 18 (24%) females and 57 (76%) males, were considered. Investigation into the distribution of individual characteristics according to gender revealed a significant difference only for smoking, with a prevalence of smokers in women (p = 0.029). At the end of follow-up, OS was higher in females (27.5% vs. 17.4%; p = 0.047). Smoking did not significantly influence OS (p = 0.055), while univariate Cox regression analysis confirmed that males had a higher risk of death (HR = 2.28, 95% CI 0.99–129 5.25), with borderline statistical significance (p = 0.053). Men showed higher PFS than women both after first-line (p = 0.051) and second-line chemotherapy (p = 0.018), with a lower risk of progression (HR = 0.29, 95% CI 0.10–0.86; p = 0.026). No differences were found between genders with regard to toxicity. Conclusions. In our series, PFS rates following first- and second-line therapies for advanced urothelial carcinoma confirmed that females have a greater risk of progression than males.
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Nik Ab Kadir MN, Hairon SM, Yaacob NM, Ab Manan A, Ali N. Prognostic Factors for Bladder Cancer Patients in Malaysia: A Population-Based Study. Int J Environ Res Public Health 2022; 19:ijerph19053029. [PMID: 35270721 PMCID: PMC8910605 DOI: 10.3390/ijerph19053029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/24/2022]
Abstract
Background: Malaysia has the third highest crude mortality rates of bladder cancer within Southeast Asia. We aimed to identify the prognostic factors for bladder cancer patients in Malaysia. Methods: A retrospective population-based study was conducted among patients diagnosed between 2007 and 2011. Death date until 31 December 2016 was updated. Cox proportional hazard regression analysis was performed to examine clinical variables as prognostic factors of death. Results: Identified prognostic factors of 1828 analyzed patients were age groups, ethnicity, morphology, stage, and surgery. As compared to patients aged 15–44, the adjusted Hazard Ratio for those aged 45–54, 55–64, 65–74, and ≥75 were 1.59, 1.87, 2.46, and 3.47, respectively. Malay and other ethnic groups had 1.22- and 1.40-times the risk of death compared to Chinese. Patients with squamous cell carcinoma were at 1.47-times the hazard of death compared to urothelial carcinoma patients. Stages II, III and IV patients had 2.20-, 2.98-, and 4.12-times the risk of death as compared to stage I. Patients who did not receive surgery were at 50% increased hazard of death. Conclusion: Early detection and/or surgery, especially for those more than 75 years old, Malay, and squamous cell carcinoma could potentially improve survival. The findings could inform national cancer control programs.
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Affiliation(s)
- Mohd Nasrullah Nik Ab Kadir
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
- Correspondence:
| | - Najib Majdi Yaacob
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Azizah Ab Manan
- Timur Laut District Health Office, Penang State Health Department, Ministry of Health Malaysia, Georgetown 11600, Penang, Malaysia;
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya 62250, Selangor, Malaysia;
| | - Nabihah Ali
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya 62250, Selangor, Malaysia;
- Public Health Medicine Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
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Nik Ab Kadir MN, Mohd Hairon S, Yaacob NM, Ab Manan A, Ali N. Survival and Characteristics of Bladder Cancer: Analysis of the Malaysian National Cancer Registry. Int J Environ Res Public Health 2021; 18:ijerph18105237. [PMID: 34069096 PMCID: PMC8156894 DOI: 10.3390/ijerph18105237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022]
Abstract
Background: Bladder cancer ranked ninth of principal male cancer in Malaysia. This study aimed to evaluate the clinical characteristics and survival of bladder cancer patients in Malaysia. Methods: A retrospective cohort study was conducted by obtaining records in the Malaysian National Cancer Registry. Patients aged 15 years old and above with diagnosis date between 2007 and 2011 were included. Death was updated until 31 December 2016. Five-year observed survival and median survival time were determined by the life table method and Kaplan–Meier estimate method. Results: Among 1828 cases, the mean (SD) age of diagnosis was 64.9 (12.5) years. The patients were predominantly men (78.7%), Malay ethnicity (49.4%) and transitional cell carcinoma (78.2%). Only 14.8% of patients were at stage I. The overall five-year observed survival and median survival time was 36.9% (95% CI: 34.6, 39.1) and 27.3 months (95% CI: 23.6, 31.0). The highest five-year observed survival recorded at stage I (67.6%, 95% CI: 62.0, 73.3) and markedly worsen at stage II (34.3%, 95% CI: 27.9, 40.8), III (25.7%, 95% CI: 18.7, 32.6) and IV (12.2%, 95% CI: 8.1, 16.3). Conclusions: Survival of bladder cancer patients in Malaysia was lower with advancing stage. The cancer control programme should be enhanced to improve survival.
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Affiliation(s)
- Mohd Nasrullah Nik Ab Kadir
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia;
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia;
- Correspondence:
| | - Najib Majdi Yaacob
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia;
| | - Azizah Ab Manan
- Timur Laut District Health Office, Penang State Health Department, Ministry of Health Malaysia, Georgetown 11600, Malaysia;
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya 62250, Malaysia;
| | - Nabihah Ali
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya 62250, Malaysia;
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Ballas LK, Navarro S, Luo C, Fossum CC, Farias A, Daneshmand S, Groshen S. Disparities in male versus female oncologic outcomes following bladder preservation: A population-based cohort study. Cancer Med 2021; 10:3004-3012. [PMID: 33779053 PMCID: PMC8085939 DOI: 10.1002/cam4.3835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/15/2021] [Accepted: 02/25/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction In surgical series of muscle‐invasive bladder cancer (MIBC), women have higher recurrence rates, disease progression, and mortality following radical cystectomy than men. Similar reports of oncologic differences between men and women following trimodality therapy (TMT) are rare. Our hypothesis was that there would be no difference in overall survival (OS) between sexes receiving TMT. Methods We queried the National Cancer Database (NCDB) for patients diagnosed with clinical stage T2‐T4aN0 M0 MIBC between 2004–2016. We considered patients to have received TMT if they received 55 Gy in 20 fractions or 59.4–70.2 Gy of radiotherapy with concurrent chemotherapy following a transurethral resection of bladder tumor (TURBT). We used multivariable Cox proportional hazard models to determine whether sex was associated with risk of mortality. In addition to OS, we calculated relative survival (RS) to adjust for the fact that females generally survive longer than males. Results Of the patients, 1960 underwent TMT and had survival data. Less than one quarter were female. In the first year following treatment, women had worse OS and RS than men (p = 0.093 and p = 0.030, respectively). However, overall and relative survival differences between sexes were not statistically significantly different in Years 2 and later. Unlike with OS, the RS between sexes remained significant at 9 years; in multivariable analysis based on RS, women were 43% more likely to die than men (p < 0.001). Conclusions Women had a higher initial risk of death than men in the first year following TMT. However, long‐term survival between sexes was similar. TMT is an important treatment option in both men and women seeking bladder preservation.
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Affiliation(s)
- Leslie K Ballas
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stephanie Navarro
- Department of Preventative Medicine, Keck School of Medicine, University of Southern CA, Los Angeles, CA, USA
| | - Chunqiao Luo
- Department of Preventative Medicine, Keck School of Medicine, University of Southern CA, Los Angeles, CA, USA
| | - Croix C Fossum
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Albert Farias
- Department of Preventative Medicine, Keck School of Medicine, University of Southern CA, Los Angeles, CA, USA
| | - Siamak Daneshmand
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Susan Groshen
- Department of Preventative Medicine, Keck School of Medicine, University of Southern CA, Los Angeles, CA, USA
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Abstract
INTRODUCTION Gender differences in urothelial carcinoma of the bladder (UCB) exist. Although men have a higher incidence of UCB, women tend to have poorer outcomes. We have explored and summarized the evidence for gender differences of UCB diagnosis and prognosis, together with reasons for these disparities. AREAS COVERED The incidence of UCB is 3-4 times higher in men than women. However, women are more likely to be diagnosed with advanced disease. Women have a higher stage-for-stage mortality compared to men, and their greatest risk of death appears to be within the first 2 years of diagnosis. Survival outcomes following radical cystectomy (RC) and radiotherapy are also poorer in women. Delays in diagnosis, differences in female anatomy, as well as poorer surgical outcomes post-RC appear to contribute significantly to the disparities noted between genders. Other factors such as exposure to risk factors, differential hormone signaling, and carcinogen breakdown may also have a role. EXPERT OPINION The gender divide in UCB outcomes has to be addressed. Improved medical and patient education and centralization of RC are recommended.
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Affiliation(s)
- Pravin Viswambaram
- Urology Research Registrar, Fiona Stanley Hospital; Master of Surgery Student, UWA Medical School, University of Western Australia (UWA) , Australia
| | - Dickon Hayne
- Head of Urology, Fiona Stanley Hospital; Professor of Urology, UWA Medical School, University of Western Australia (UWA); Chair of Bladder Urothelial and Penile Cancer Sub-committee, Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group , Australia
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Park JY. Risk Factors for Recurrence and Progression of Nonmuscle Invasive Bladder Cancer. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ha YS, Kim TH. The Surveillance for Muscle-Invasive Bladder Cancer (MIBC). Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Burge F, Kockelbergh R. Closing the Gender Gap: Can We Improve Bladder Cancer Survival in Women? - A Systematic Review of Diagnosis, Treatment and Outcomes. Urol Int 2016; 97:373-379. [PMID: 27595416 DOI: 10.1159/000449256] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 08/19/2016] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Despite recent attention, there are no gender specific guidelines to address the disparity in bladder cancer survival between the sexes. The focus of this review was to identify areas of clinical practice that may influence bladder cancer outcomes and to provide evidence-based recommendations to improve bladder cancer survival in women. METHOD A systematic search of MEDLINE was conducted to identify studies related to referral, diagnosis, treatment and outcomes of patients with bladder cancer with particular reference to gender differences. RESULTS Patients' knowledge of key signs and symptoms of bladder cancer is poor. There is evidence that there is a gender difference in referral patterns both at patient and primary care level. The presence of cystits, in particular, delays referral. Treatment and surveillance of high-risk non-muscle invasive cancers is variable and non-urothelial bladder cancer, which has higher incidence in women is more likely to be treated non-operatively than urothelial bladder cancer. CONCLUSION We have offered recommendations to improve patient education and streamline referrals and suggested considerations for treatment of high-risk cancers to help improve survival in female bladder cancer patients.
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Affiliation(s)
- Frances Burge
- Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Abstract
A gender discrepancy exists in the incidence of both urothelial and kidney carcinomas, with more men presenting with these cancers than women. Men have a threefold greater risk of developing bladder cancer than women, but female gender has been identified as an independent adverse prognostic factor for both recurrence and progression of this disease. In particular, women with bladder cancer are often diagnosed with a higher tumour stage than men. Conclusive data on the influence of gender on outcomes of patients with upper tract urothelial carcinoma are currently lacking, although men seem to have a higher disease incidence, whereas survival outcomes might be independent of gender. Patients with renal cell carcinoma are more often men and they typically have larger tumours and higher stage and grade disease than women with this cancer. Smoking habits, tumour biology, occupational risk factors and sex steroid hormones and their receptors could have a role in these observed gender disparities. The majority of data support the theory that gender influences incidence and prognosis of urothelial and kidney cancers; men and women are different genetically and socially, making the consideration of gender a key factor in the clinical decision-making process. Thus, the inclusion of this variable in validated prognostic tables and nomograms should be discussed as a matter of importance.
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Affiliation(s)
- Ilaria Lucca
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Harun Fajkovic
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Michela de Martino
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria
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Wolff I, Brookman-may S, May M. Sex difference in presentation and outcomes of bladder cancer: biological reality or statistical fluke? Curr Opin Urol 2015; 25:418-26. [DOI: 10.1097/mou.0000000000000198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Waldhoer T, Berger I, Haidinger G, Zielonke N, Madersbacher S. Sex Differences of ≥pT1 Bladder Cancer Survival in Austria: A Descriptive, Long-Term, Nation-Wide Analysis Based on 27,773 Patients. Urol Int 2015; 94:383-9. [DOI: 10.1159/000368418] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/17/2014] [Indexed: 11/19/2022]
Abstract
Introduction: In recent days, the relationship between gender, tumour stage and survival of bladder cancer has attracted interest. Materials and Methods: The Austrian cancer registry was linked to the national death statistics. All patients with urothelial cancer of the urinary bladder with stages pT1, pT2, pT3 and pT4 diagnosed between 1983 until 2012 were followed for up to 15 years. Overall and cancer-specific mortality were estimated by cumulative incidence. Results: A total of 27,773 patients were analysed. The male:female ratio declined from 3:1 for stage pT1-tumours (n = 16,416) to 2.6:1 for pT2 (n = 6,548), 2.1:1 for pT3 (n = 3,111) and 1.9:1 for pT4 (n = 1,698). The 5 years cumulative overall death rate for pT1 tumours was slightly lower for women (0.31 vs. 0.32; p = 0.016). The opposite was observed for more advanced tumour stages: pT2: women 0.66, men: 0.60 (p = 0.0001); pT3: women 0.76, men 0.72 (p = 0.0004) and for pT4: women 0.90, men 0.85 (p = 0.0001). Cancer-specific survival was identical for pT1-tumours in both sexes, while women had a worse cancer-specific survival in both age cohorts (<70 years and ≥70 years) with higher tumour stages. Conclusions: This population-based study demonstrates that (1) a rise of advanced bladder cancer stages in women and (2) that women with tumour stages >pT1 have a shorter cancer-specific and overall survival.
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Aziz A, Madersbacher S, Otto W, Mayr R, Comploj E, Pycha A, Denzinger S, Fritsche HM, Burger M, Gierth M. Comparative Analysis of Gender-Related Differences in Symptoms and Referral Patterns prior to Initial Diagnosis of Urothelial Carcinoma of the Bladder: A Prospective Cohort Study. Urol Int 2014; 94:37-44. [DOI: 10.1159/000363334] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/29/2014] [Indexed: 11/19/2022]
Abstract
Objective: To analyze gender-specific differences regarding clinical symptoms, referral patterns and tumor biology prior to initial diagnosis of urothelial carcinoma of the bladder (UCB). Methods: A consecutive series of patients with an initial diagnosis of UCB was included. All patients completed a questionnaire on demographics, clinical symptoms and referral patterns. Results: In total, 68 patients (50 men, 18 women) with newly diagnosed UCB at admission for transurethral resection of bladder tumors were recruited. Dysuria was more often observed in women (55.6 vs. 38.0%, p = 0.001). Direct consultation of the urologist was conducted by 84.0% of males and 66.7% of females (p = 0.120). One third of the women saw their general practitioner and/or gynecologist once or twice (p = 0.120) before referral to the urologist. Furthermore, women were significantly more often treated for urinary tract infections than men (61.1 vs. 20.0%, p = 0.005). Cystoscopy at first presentation to the urologist was more often performed in men than women (88.0 vs. 66.7%, p = 0.068), with a more favorable tumor detection rate at first cystoscopy in men (96.0 vs. 50.0%, p < 0.001). Conclusions: Delayed referral patterns might lead to deferred diagnosis of UCB and consequently to adverse outcome. Thus, primary care physicians might consider referring patients with bladder complaints to specialized care earlier.
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Keck B, Wach S, Taubert H, Zeiler S, Ott OJ, Kunath F, Hartmann A, Bertz S, Weiss C, Hönscheid P, Schellenburg S, Rödel C, Baretton GB, Sauer R, Fietkau R, Wullich B, Krause FS, Datta K, Muders MH. Neuropilin-2 and its ligand VEGF-C predict treatment response after transurethral resection and radiochemotherapy in bladder cancer patients. Int J Cancer 2014; 136:443-51. [PMID: 24862180 DOI: 10.1002/ijc.28987] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/30/2014] [Accepted: 04/25/2014] [Indexed: 12/11/2022]
Abstract
The standard treatment for invasive bladder cancer is radical cystectomy. In selected patients, bladder-sparing therapy can be performed by transurethral resection (TURBT) and radio-chemotherapy (RCT) or radiotherapy (RT). Our published in vitro data suggest that the Neuropilin-2 (NRP2)/VEGF-C axis plays a role in therapy resistance. Therefore, we studied the prognostic impact of NRP2 and VEGF-C in 247 bladder cancer patients (cN0M0) treated with TURBT and RCT (n = 198) or RT (n = 49) and a follow-up time up to 15 years. A tissue microarray was analyzed by immunohistochemistry. NRP2 expression emerged as a prognostic factor in overall survival (OS; HR: 3.42; 95% CI: 1.48 - 7.86; p = 0.004) and was associated with a 3.85-fold increased risk of an early cancer specific death (95% CI: 0.91 - 16.24; p = 0.066) in multivariate analyses. Cancer specific survival (CSS) dropped from 166 months to 85 months when NRP2 was highly expressed (p = 0.037). Patients with high VEGF-C expression have a 2.29-fold increased risk of shorter CSS (95% CI: 1.03-5.35; p = 0.043) in univariate analysis. CSS dropped from 170 months to 88 months in the case of high VEGF-C expression (p = 0.041). Additionally, NRP2 and VEGF-C coexpression is a prognostic marker for OS in multivariate models (HR: 7.54; 95% CI: 1.57-36.23; p = 0.012). Stratification for muscle invasiveness (T1 vs. T2-T4) confirmed the prognostic role of NRP2 and NRP2/VEGF-C co-expression in patients with T2-T4 but also with high risk T1 disease. In conclusion, immunohistochemistry for NRP2 and VEGF-C has been determined to predict therapy outcome in bladder cancer patients prior to TURBT and RCT.
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Affiliation(s)
- B Keck
- Department of Urology, University Hospital Erlangen, Germany
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17
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Ploussard G, Daneshmand S, Efstathiou JA, Herr HW, James ND, Rödel CM, Shariat SF, Shipley WU, Sternberg CN, Thalmann GN, Kassouf W. Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review. Eur Urol 2014; 66:120-37. [PMID: 24613684 DOI: 10.1016/j.eururo.2014.02.038] [Citation(s) in RCA: 223] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/14/2014] [Indexed: 12/17/2022]
Abstract
CONTEXT Aims of bladder preservation in muscle-invasive bladder cancer (MIBC) are to offer a quality-of-life advantage and avoid potential morbidity or mortality of radical cystectomy (RC) without compromising oncologic outcomes. Because of the lack of a completed randomised controlled trial, oncologic equivalence of bladder preservation modality treatments compared with RC remains unknown. OBJECTIVE This systematic review sought to assess the modern bladder-preservation treatment modalities, focusing on trimodal therapy (TMT) in MIBC. EVIDENCE ACQUISITION A systematic literature search in the PubMed and Cochrane databases was performed from 1980 to July 2013. EVIDENCE SYNTHESIS Optimal bladder-preservation treatment includes a safe transurethral resection of the bladder tumour as complete as possible followed by radiation therapy (RT) with concurrent radiosensitising chemotherapy. A standard radiation schedule includes external-beam RT to the bladder and limited pelvic lymph nodes to an initial dose of 40 Gy, with a boost to the whole bladder to 54 Gy and a further tumour boost to a total dose of 64-65 Gy. Radiosensitising chemotherapy with phase 3 trial evidence in support exists for cisplatin and mitomycin C plus 5-fluorouracil. A cystoscopic assessment with systematic rebiopsy should be performed at TMT completion or early after TMT induction. Thus, nonresponders are identified early to promptly offer salvage RC. The 5-yr cancer-specific survival and overall survival rates range from 50% to 82% and from 36% to 74%, respectively, with salvage cystectomy rates of 25-30%. There are no definitive data to support the benefit of using of neoadjuvant or adjuvant chemotherapy. Critical to good outcomes is proper patient selection. The best cancers eligible for bladder preservation are those with low-volume T2 disease without hydronephrosis or extensive carcinoma in situ. CONCLUSIONS A growing body of accumulated data suggests that bladder preservation with TMT leads to acceptable outcomes and therefore may be considered a reasonable treatment option in well-selected patients. PATIENT SUMMARY Treatment based on a combination of resection, chemotherapy, and radiotherapy as bladder-sparing strategies may be considered as a reasonable treatment option in properly selected patients.
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Affiliation(s)
- Guillaume Ploussard
- Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada; Department of Urology, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Siamak Daneshmand
- University of Southern California Institute of Urology, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Harry W Herr
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nicholas D James
- University of Birmingham, School of Cancer Sciences, Edgbaston, Birmingham, UK
| | - Claus M Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany
| | | | - William U Shipley
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada.
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Karaoglu I, van der Heijden AG, Witjes JA. The role of urine markers, white light cystoscopy and fluorescence cystoscopy in recurrence, progression and follow-up of non-muscle invasive bladder cancer. World J Urol 2013; 32:651-9. [PMID: 24166285 DOI: 10.1007/s00345-013-1035-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/29/2013] [Indexed: 01/04/2023] Open
Abstract
Non-muscle invasive bladder cancer (NMIBC) accounts for approximately 70 % of all bladder cancer cases and represents a heterogeneous pathological entity, characterized by a variable natural history and oncological outcome. The combination of cystoscopy and urine cytology is considered the gold standard in the initial diagnosis of bladder cancer, despite the limited sensitivity. The first step in NMIBC management is transurethral resection of the bladder tumour (TURBT). This procedure is marked by a significant risk of leaving residual disease. The primary landmark in NMIBC is the high recurrence rate. Fluorescence cystoscopy improves the bladder cancer detection rate, especially for flat lesions, and improves the recurrence-free survival by decreasing residual tumour. Progression to muscle invasive tumours constitutes the second important landmark in NMIBC evolution. Stage, grade, associated CIS and female gender are the major prognostic factors in this regard. The evolution to MIBC has a major negative impact upon the survival rate and quality of life of these patients. Fluorescence cystoscopy improves the detection rate of bladder cancer but does not improve the progression-free survival. Urine markers such as ImmunoCyt and Uro Vysion (FISH) have also limited additional value in diagnosis and prognosis of NMIBC patients. Major drawbacks are the requirement of a specialized laboratory and the additional costs. In this review, the risks of recurrence and progression are analysed and discussed. The impact of white light cystoscopy, fluorescence cystoscopy and urine markers is reviewed. Finally, the means and recommendations regarding follow-up are discussed.
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Affiliation(s)
- Ilhan Karaoglu
- Universitair Medisch Centrum Radboud, Nijmegen, The Netherlands,
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Kunath F, Keck B, Bertz S, Brookman-May S, May M, Vergho D, Hartmann A, Riedmiller H, Wullich B, Burger M. Is gender becoming relevant in uro-oncological research? A bibliographical analysis. World J Urol 2013; 31:1065-72. [PMID: 23568444 DOI: 10.1007/s00345-013-1069-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/27/2013] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Gender differences are increasingly recognized as important in numerous diseases and found to be relevant in various cancer entities. While a larger number of manuscripts on gender effects in gastro-intestinal and pulmonary neoplasms have been published, urological malignancies involving men and women alike seem less studied in this regard. The present analysis aimed at describing the role of gender effects in general oncological and uro-oncological research and is the first such bibliometrical analysis. METHODS The electronic database MEDLINE was searched for relevant medical subject headings from January 1991 to December 2011. Publication types, publishing journal and impact factors were identified. Trends were assessed by linear regression. RESULTS The numbers of annual publications on all major tumour entities and on urological malignancies increased similarly. While the portion of publications on gender effects was below 1 % for each tumour entity, the annual increase of novel publications on gender effects was significant in most and prominent in pulmonary (1.87, 95 % CI 1.11-2.63; <0.0001) and colorectal neoplasms (2.16, 95 % CI 1.49-2.82; <0.0001). While the annual increase of novel publications on gender effects was significant in bladder cancer (0.33, 95 % CI 0.11-0.54; 0.005), it failed level of significance in renal cell cancer (0.25, 95 % CI -0.19-0.24; 0.82). CONCLUSION While the overall role of gender effect seems small in general oncological research, it is increasing steadily. In uro-oncological research, such trend is also visible in bladder but not in renal cell cancer. Respective awareness on importance of gender effects should be raised.
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Affiliation(s)
- Frank Kunath
- Department of Urology, University of Erlangen, Erlangen, Germany
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