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

A study recently published in the journal Urology to investigate the association of female sex with the selected treatment for patients with nonmetastatic muscle-invasive bladder cancer was conducted by several urology experts, including UPMC Department of Urology physicians Robert M. Turner, MD, Benjamin J. Davies, MD, and Bruce L. Jacobs, MD, MPH.

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-Medicare data set, the doctors identified 6,809 patients initially diagnosed with nonmetastatic muscle-invasive bladder cancer between 2004 and 2014. They fit multivariable logistic regression and Cox models to assess the relationship of sex with treatment modality and survival adjusting for differences in patient characteristics.

The findings were that, 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 (odds ratios [OR] 1.39; 95% confidence intervals [CI] 1.20-1.61).
• Present at an older age with less comorbidities compared to men (P <.001).
• Have worse bladder cancer-specific survival (CSS) than men (hazard ratio [HR] 1.18; 95% CI 1.05-1.32).
• Have lower mortality from other causes (HR 0.78; 95% CI 0.70-0.86).

Women showed no difference in overall survival (OS) (female HR 0.93; 0.86-1.01). There were no differences in OS and CSS by sex in patients with stage pT4a.

The research concluded that 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.

Read more about this study on PubMed.

Other study authors include: 

• Valentina Grajales
• Jathin Bandari
• Nathan E. Hale
• Jonathan G. Yabes
• Mina M. Fam
• Lindsay M. Sabik
• Jeffrey R. Gingrich