Differential Effect of Sex on Outcomes After Radical Surgery for Upper Tract and Bladder Urothelial Carcinoma: A Systematic Review and Meta-Analysis.

PURPOSE To assess the prognostic value of sex differences in upper tract urothelial carcinoma (UTUC) and urothelial carcinoma in bladder (UCB) treated with radical surgery. METHODS The PUBMED, Web of Science, Cochrane Library, and Scopus databases were searched in July 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared overall, cancer-specific, and recurrence-free survival in UTUC and UCB patients. Formal meta-analyses were performed for these outcomes according to sex differences. RESULTS 66 studies with 100,389 UCB patients and 40 studies with 39,759 UTUC patients were eligible for review and meta-analysis. Females in UCB were associated with worse cancer-specific survival (pooled hazard ratio [HR]: 1.20, 95% confidence interval [CI]: 1.10-1.31), overall survival (pooled HR: 1.03, 95% CI: 1.01-1.05), and recurrence-free survival (pooled HR: 1.13, 95% CI: 1.02-1.25). In contrast, those in UTUC were not associated with cancer-specific survival (pooled HR: 0.94, 95% CI: 0.89-1.00), overall survival (pooled HR: 0.98, 95% CI: 0.95-1.01), and recurrence-free survival (pooled HR: 0.90, 95% CI: 0.78-1.03). CONCLUSIONS Sex is shown to be associated with cancer-specific mortality, overall mortality, and disease recurrence in UCB but not in UTUC. Given the genetic and social differences between sex, sex differences may represent a key factor in the clinical decision-making process.

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