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        Impact of sex on response to neoadjuvant chemotherapy in patients with bladder cancer

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        Author
        D'Andrea, David
        Black, Peter C.
        Zargar, Homayoun
        Zargar-Shoshtari, Kamran
        Zehetmayer, Sonja
        Fairey, Adrian S.
        Mertens, Laura S.
        Dinney, Colin P.
        Mir, Maria C.
        Krabbe, Laura Maria
        Cookson, Michael S.
        Jacobsen, Niels Erik
        Montgomery, Jeffrey S.
        Vasdev, Nikhil
        Yu, Evan Y.
        Xylinas, Evanguelos
        Campain, Nicholas J.
        Kassouf, Wassim
        Dall'Era, Marc A.
        Seah, Jo An
        Ercole, Cesar E.
        Horenblas, Simon
        Sridhar, Srikala S.
        McGrath, John S.
        Aning, Jonathan
        Wright, Jonathan L.
        Thorpe, Andrew C.
        Morgan, Todd M.
        Holzbeierlein, Jeffrey M.
        Bivalacqua, Trinity J.
        North, Scott
        Barocas, Daniel A.
        Lotan, Yair
        Grivas, Petros
        Stephenson, Andrew J.
        Shah, Jay B.
        van Rhijn, Bas W.
        Daneshmand, Siamak
        Spiess, Philippe E.
        Shariat, Shahrokh F.
        Attention
        2299/22726
        Abstract
        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.
        Publication date
        2020-02-11
        Published in
        Urologic Oncology: Seminars and Original Investigations
        Published version
        https://doi.org/10.1016/j.urolonc.2020.01.010
        License
        http://creativecommons.org/licenses/by-nc-nd/4.0/
        Other links
        http://hdl.handle.net/2299/22726
        Relations
        School of Life and Medical Sciences
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