Gender Specific Differences in Disease Free, Cancer Specific and Overall Survival after Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta Analysis
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(r) Embase(r) 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.
The Journal of urology