(UroToday.com) The 2023 American Urological Association (AUA) annual meeting held in Chicago, IL, was host to an upper tract transitional cell carcinoma podium session. Dr. Jeffrey Orf discussed his group’s study evaluating gender disparities in upper tract urothelial carcinoma (UTUC) using the National Cancer Database (NCDB).
Previous studies have demonstrated that women with urothelial carcinoma of the bladder were more likely to present with more advanced disease, have higher rates of treatment complications, and worse survival outcomes. Differences in sex-specific outcomes have not been fully evaluated in the UTUC disease space, particularly at the population level. As such, the goal was to compare sex-specific presentation patterns, neoadjuvant chemotherapy usage, and survival outcomes for UTUC patients.
The authors queried the NCDB for all patients with UTUC of the renal pelvis undergoing a radical nephroureterectomy between 2004 and 2016. Patient sex, demographic, clinical stage, and use of neoadjuvant chemotherapy data were available. The study outcomes of interest were 30- and 90-day readmission rates, positive margins, and mortality outcomes across sexes.
Female patients were slightly older at diagnosis (72.4 versus 70 years). Clinical stage at presentation was similar for both males and females. High grade disease at presentation was present in 63% of females, compared to 61% of men at presentation. There were no clinically significant differences in:
- Use of neoadjuvant chemotherapy
- Positive margins status
- Length of stay
- 30-day readmission rates
- 30- and 90-day mortality rates
Next, the authors compared overall survival outcomes between sexes, stratified by pathologic stage. Interestingly, female patients with pT0-T1 disease had significantly longer survival times compared to male patients with pT0-1 disease (99 versus 91 months, p=0.02). There were no sex-specific differences in overall survival for patients with pT2-4 disease.
On aggregate survival analysis, there were no significant differences in OS between males and females with UTUC of the renal pelvis undergoing a radical nephroureterectomy.
Based on these results, Dr. Orf concluded that sex-specific disparities previously reported with urothelial carcinoma of the bladder do not appear to hold true for patients with UTUC of the renal pelvis undergoing a radical nephroureterectomy.
Presented by: Jeffrey Orf, MD, Resident Physician, Department of Urology, Saint Louis University, St Louis, MO
Written by: Rashid K. Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023