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Meta-Analysis
. 2018 Jul;200(1):48-60.
doi: 10.1016/j.juro.2017.11.150. Epub 2018 Mar 1.

Gender Specific Differences in Disease-Free, Cancer Specific and Overall Survival after Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis

Annemarie Uhlig  1 , Ali Seif Amir Hosseini  2 , Jörg Simon  3 , Joachim Lotz  2 , Lutz Trojan  4 , Marianne Schmid  4 , Johannes Uhlig  5
Affiliations
Meta-Analysis

Gender Specific Differences in Disease-Free, Cancer Specific and Overall Survival after Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis

Annemarie Uhlig et al. J Urol. 2018 Jul.

Abstract

Purpose: We summarize the evidence on gender specific differences in disease-free, cancer specific and overall survival after radical cystectomy for bladder cancer.

Materials and methods: We performed a systematic literature search of MEDLINE®, Embase® and the Cochrane Library in July 2017. Studies evaluating gender specific differences in disease-free, cancer specific or overall survival after radical cystectomy for bladder cancer were included in study. Analyses included random effect meta-analysis, subgroup analyses, meta-influence and cumulative meta-analyses. Funnel plots and the Egger test were used to assess publication bias.

Results: Of the 3,868 studies identified during the literature search 59 published between 1998 and 2017 were included in analysis. Of the studies 30 in a total of 38,321 patients evaluated disease-free survival, 44 in a total of 69,666 evaluated cancer specific survival and 26 in a total of 30,039 evaluated overall survival. Random effect meta-analyses revealed decreased disease-free, cancer specific survival and overall survival in female patients than in their male counterparts. Pooled estimates showed a HR of 1.16 (95% CI 1.06-1.27, p = 0.0018) for disease-free survival, 1.23 (95% CI 1.15-1.31, p <0.001) for cancer specific survival and 1.08 (95% CI 1.03-1.12, p = 0.0004) for overall survival. Subgroup analyses confirmed impaired disease-free, cancer specific and overall survival in female patients in all strata. Publication bias was evident only for studies of cancer specific survival (Egger test p = 0.0029). After adjusting for publication bias by the trim and fill method the corrected pooled estimated HR of cancer specific survival was 1.13 (95% CI 1.05-1.21, p = 0.0012).

Conclusions: Female patients who underwent radical cystectomy for bladder cancer demonstrated worse disease-free, cancer specific and overall survival than their male counterparts. The multifactorial etiology might include epidemiological differences, gender specific health care discrepancies and hormonal influences.

Keywords: cystectomy; female; male; mortality; urinary bladder neoplasms.

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Comment in

  • Editorial Comment.
    Meeks JJ, Glaser AP. Meeks JJ, et al. J Urol. 2018 Jul;200(1):60. doi: 10.1016/j.juro.2017.11.157. Epub 2018 Apr 19. J Urol. 2018. PMID: 29679580 No abstract available.
  • Editorial Comment.
    Filson CP. Filson CP. J Urol. 2018 Jul;200(1):59. doi: 10.1016/j.juro.2017.11.155. Epub 2018 Apr 19. J Urol. 2018. PMID: 29679581 No abstract available.
  • Editorial Comment.
    Haifler M. Haifler M. J Urol. 2018 Jul;200(1):59-60. doi: 10.1016/j.juro.2017.11.156. Epub 2018 Apr 19. J Urol. 2018. PMID: 29679582 No abstract available.