Females undergoing chemo-radiation for muscle-invasive bladder cancer have poorer outcomes than males, according to findings published in Urology.
Results from 10 centers across Canada revealed that cancer-specific survival, but not overall survival, was significantly poorer among women treated with chemotherapy and radiation.
Sex disparities in cancer treatment responses and outcomes are influenced by a variety of factors, including genetics and hormones. While females with cancer often have a better prognosis than males, the opposite is typically seen among individuals with bladder cancer.
The gold standard for muscle invasive bladder cancer has traditionally involved chemotherapy followed by surgery to remove the bladder and surrounding lymph nodes. However, trimodal therapy, which relies on a combination of tumor removal, chemotherapy and radiation, has emerged as a potential alternative.
Read more about bladder cancer prognosis
“Chemo-radiation has demonstrated promising results for those patients deemed to be candidates, with some studies suggesting equivalent cancer outcomes with less morbidity,” the researchers explained.
The study included 397 males and 145 females who underwent chemo-radiation for nonmetastatic muscle invasive bladder cancer between 2001 and 2018. Participants were followed for a median of 30 months.
The cancer specific survival rate at three years was 78.4% among males and 70.4% among females.
Males had a median overall survival of 81 months, compared with 52 months among females. However, this difference was not statistically significant.
In addition, hydronephrosis, or swelling of the kidneys, was more prominent among females than males. In a statistical model, hydronephrosis was independently associated with worse cancer specific survival.
Males and females had similar rates of complete response and bladder removal surgery following treatment. Tumor stage was associated with complete response rates in both males and females.
“Future investigations should explore potential effects from differences in staging, as well as other biological- and treatment-related factors, including differential responses to chemo-sensitized radiation,” the authors concluded.
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