TY - JOUR
T1 - Impact of sex on response to neoadjuvant chemotherapy in patients with bladder cancer
AU - D'Andrea, David
AU - Black, Peter C.
AU - Zargar, Homayoun
AU - Zargar-Shoshtari, Kamran
AU - Zehetmayer, Sonja
AU - Fairey, Adrian S.
AU - Mertens, Laura S.
AU - Dinney, Colin P.
AU - Mir, Maria C.
AU - Krabbe, Laura Maria
AU - Cookson, Michael S.
AU - Jacobsen, Niels Erik
AU - Montgomery, Jeffrey S.
AU - Vasdev, Nikhil
AU - Yu, Evan Y.
AU - Xylinas, Evanguelos
AU - Campain, Nicholas J.
AU - Kassouf, Wassim
AU - Dall'Era, Marc A.
AU - Seah, Jo An
AU - Ercole, Cesar E.
AU - Horenblas, Simon
AU - Sridhar, Srikala S.
AU - McGrath, John S.
AU - Aning, Jonathan
AU - Wright, Jonathan L.
AU - Thorpe, Andrew C.
AU - Morgan, Todd M.
AU - Holzbeierlein, Jeffrey M.
AU - Bivalacqua, Trinity J.
AU - North, Scott
AU - Barocas, Daniel A.
AU - Lotan, Yair
AU - Grivas, Petros
AU - Stephenson, Andrew J.
AU - Shah, Jay B.
AU - van Rhijn, Bas W.
AU - Daneshmand, Siamak
AU - Spiess, Philippe E.
AU - Shariat, Shahrokh F.
N1 - © 2020 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/.
PY - 2020/2/11
Y1 - 2020/2/11
N2 - Objective: To assess the effect of patient's sex on response to neoadjuvant chemotherapy (NAC) in patients with clinically nonmetastatic muscle-invasive bladder cancer (MIBC). Methods: Complete pathologic response, defined as ypT0N0 at radical cystectomy, and downstaging were evaluated using sex-adjusted univariable and multivariable logistic regression modeling. We used interaction terms to account for age of menopause and smoking status. The association of sex with overall survival and cancer-specific survival was evaluated using Cox regression analyses. Results: A total of 1,031 patients were included in the analysis, 227 (22%) of whom were female. Female patients had a higher rate of extravesical disease extension (P = 0.01). After the administration of NAC, ypT stage was equally distributed between sexes (P = 0.39). On multivariable logistic regression analyses, there was no difference between the sexes or age of menopause with regards to ypT0N0 rates or downstaging (all P > 0.5). On Cox regression analyses, sex was associated with neither overall survival (hazard ratio 1.04, 95% confidence interval 0.75–1.45, P = 0.81) nor cancer-specific survival (hazard ratio 1.06, 95% confidence interval 0.71–1.58, P = 0.77). Conclusion: Our study generates the hypothesis that NAC equalizes the preoperative disparity in pathologic stage between males and females suggesting a possible differential response between sexes. This might be the explanation underlying the comparable survival outcomes between sexes despite females presenting with more advanced tumor stage.
AB - Objective: To assess the effect of patient's sex on response to neoadjuvant chemotherapy (NAC) in patients with clinically nonmetastatic muscle-invasive bladder cancer (MIBC). Methods: Complete pathologic response, defined as ypT0N0 at radical cystectomy, and downstaging were evaluated using sex-adjusted univariable and multivariable logistic regression modeling. We used interaction terms to account for age of menopause and smoking status. The association of sex with overall survival and cancer-specific survival was evaluated using Cox regression analyses. Results: A total of 1,031 patients were included in the analysis, 227 (22%) of whom were female. Female patients had a higher rate of extravesical disease extension (P = 0.01). After the administration of NAC, ypT stage was equally distributed between sexes (P = 0.39). On multivariable logistic regression analyses, there was no difference between the sexes or age of menopause with regards to ypT0N0 rates or downstaging (all P > 0.5). On Cox regression analyses, sex was associated with neither overall survival (hazard ratio 1.04, 95% confidence interval 0.75–1.45, P = 0.81) nor cancer-specific survival (hazard ratio 1.06, 95% confidence interval 0.71–1.58, P = 0.77). Conclusion: Our study generates the hypothesis that NAC equalizes the preoperative disparity in pathologic stage between males and females suggesting a possible differential response between sexes. This might be the explanation underlying the comparable survival outcomes between sexes despite females presenting with more advanced tumor stage.
KW - Bladder cancer
KW - Neoadjuvant chemotherapy
KW - Response
KW - Sex
UR - http://www.scopus.com/inward/record.url?scp=85079152713&partnerID=8YFLogxK
U2 - 10.1016/j.urolonc.2020.01.010
DO - 10.1016/j.urolonc.2020.01.010
M3 - Article
AN - SCOPUS:85079152713
SN - 1078-1439
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
ER -