Abstract
Objective: The objective of this article is to investigate why bladder cancer (BC) survival is worse in females using national cancer datasets. Patients and methods: All BC diagnoses since the year 2000 were identified from the National Cancer Data Repository (NCDR) using ICD-10 Code C67 (Bladder cancer T1–T4). Age-standardised relative survival rates for males and females diagnosed with BC between 2000 and 2010 were obtained from Public Health England. Results: Five-year relative survival of men with transitional cell carcinoma (TCC) BC (Code C67) was 61%, but in females was significantly less at 52%. One in four female BC (27%) patients are non-TCC, proportionately far more compared to 1:6 (16%) non-TCC BC in males. Five-year relative survival in non-TCC BC subtypes was notably reduced to 23% in females compared to 35% in men. Only 47% of patients with non-TCC BC receive surgical treatment compared to 82% for all BC. Conclusion: Relative survival from non-TCC BC is significantly less than the overall survival from TCC BC. Female patients with invasive BC have a worse survival than men. This is partly explained by the proportionately higher incidence of non-TCC BC in females, but women with TCC BC also have worse outcomes so other factors must contribute. Female gender should be recognised as an adverse risk factor in BC survival and influence management decisions.
Highlights
Bladder cancer (BC) is notable as one of the few cancers for which women have worse survival than men
The relative survival from non-transitional cell carcinoma (TCC) BC is significantly less than the overall survival from TCC BC
The relative survival from non-transitional cell carcinomas (non-TCC) BC is significantly less than the overall survival from TCC BC, and treatment options are limited in this group
Summary
Bladder cancer (BC) is notable as one of the few cancers for which women have worse survival than men. The finding that BC is less common in females but survival is worse is atypical in the cancer landscape and has recently ignited further research.[3] Gender discrepancy in causation of BC, in particular less industrial exposure in women, is expected but we question whether differences in the epidemiology of BC histology might partly explain poor survival in women. The remainder are non-transitional cell carcinomas (non-TCC) and include squamous cell, sarcoma, small cell and adenocarcinoma. It is not clear whether the epidemiology of these less-common types of BC is different compared to transitional cell carcinoma (TCC), and if so whether treatment options and outcomes differ . In this study we used national cancer datasets to investigate differences in the epidemiology of BC histology and the relationship to survival outcomes in women
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