Introduction:
The incidence of urothelial carcinoma of the bladder is lower in women but women present with more aggressive and advanced disease. The literature to date on whether sex-based differences exist in response to intravesical BCG treatment for non-muscle invasive bladder tumors remains inconsistent and better studies are needed. The objective of this study is to evaluate the relationship between gender and response to intravesical BCG treatments.
Methods:
Patients who received intravesical BCG at the Hôtel-Dieu de Québec Hospital in the CHU de Québec Center – Laval University from 2009 to 2019 following a transurethral resection for urothelial carcinoma were identified by pharmacy records. Tolerability was defined according to the proportion of prescribed BCG received. All clinical details where obtained through medical chart review, corroborated by pharmacy records for BCG administration. Kaplan-Meier and adjusted cox-regression analyses compared outcomes of recurrence and progression following BCG treatment. Recurrence was defined by pathologic findings, while progression was defined as the new development of high-grade pathology or an increase of stage.
Results:
A total of 418 men and 112 women were treated with intravesical BCG during the study period, with a median follow up of 3.7 years. Kaplan-Meier analysis demonstrated that women have greater risk of recurrence (p=0.017) as well as pathological progression (p<0.001). Similarly, multivariable cox regression analysis demonstrated that female gender (hazard ratio (HR) = 1.67) was associated with a higher risk of recurrence, following adjustment for smoking status, tumor size, multiplicity, initial tumor stage, grade, and presence of CIS. Moreover, female gender was also associated with a 3-fold greater risk (HR=2.96) of progression compared to male gender on adjusted cox regression analysis. Interestingly, these significant differences occurred despite the observation that BCG treatments were better tolerated by female patients with 45% completing the full BCG protocol compared to 31% of male patients.
Conclusion:
Female patients have a significantly higher risk of both recurrence and progression following intravesical BCG treatment compared to male patients. Further research is needed to understand the biological reasons for these differences and develop strategies to improve outcomes.
Funding: N/A
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Sex differences in the effectiveness of intravesical BCG for non-muscle invasive bladder cancer
Category
Bladder Cancer > Non-Muscle Invasive Bladder Cancer
Description
Poster #32
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Presented By: Jonathan Fadel
Authors:
Jonathan Fadel
Jean-Simon Harvey
Guillaume Lanteigne
Michele Lodde
Louis Lacombe
Yves Fradet
Paul-Jeremy Toren