Urologic oncology · 2026
Sex-based prognostic differences in upper tract urothelial carcinoma: A multicenter cohort study from Taiwan.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Chang Hao-Han, Tsai Yao-Chou, Yu Chih-Chin, Lin Wun-Rong, Chen Marcelo, Huang Chi-Ping, Li Wei-Ming, Tang Tsz-Yi, Lee Hsiang Ying
Аннотация
OBJECTIVE: To investigate sex-based differences in oncologic outcomes and prognostic factors in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU) in a large multicenter cohort from Taiwan.
METHODS: We retrospectively analyzed 1,337 patients with UTUC (565 men and 772 women) who underwent RNU with bladder cuff excision across 21 hospitals in Taiwan. Survival outcomes, including overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS), were evaluated using Kaplan-Meier analysis and Cox proportional hazards models. Overlap weighting based on propensity scores was applied to balance baseline characteristics between sexes. Sex-stratified multivariable analyses were further performed to identify prognostic factors in men and women separately.
RESULTS: There were no significant sex-based differences in OS, CSS, or DFS. In contrast, female patients had significantly better BRFS than male patients on Kaplan-Meier analysis (P < 0.001), and this association remained significant after overlap weighting adjustment. In multivariable analysis, female sex was independently associated with a lower risk of bladder recurrence after RNU (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.46-0.71; P < 0.001). Established adverse prognostic factors for survival outcomes included poor Eastern Cooperative Oncology Group performance status, advanced pathological stage, lymphovascular invasion, and positive surgical margins. Sex-stratified analyses further showed differences in prognostic profiles between men and women across survival endpoints.
CONCLUSIONS: In this large multicenter Taiwanese cohort, sex was not associated with OS, CSS, or DFS after RNU for UTUC. However, female patients had a significantly lower risk of intravesical recurrence, independent of clinicopathological factors. These findings suggest that sex-specific biological or clinical factors may influence bladder recurrence after RNU and support consideration of sex-informed postoperative surveillance strategies.
METHODS: We retrospectively analyzed 1,337 patients with UTUC (565 men and 772 women) who underwent RNU with bladder cuff excision across 21 hospitals in Taiwan. Survival outcomes, including overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS), were evaluated using Kaplan-Meier analysis and Cox proportional hazards models. Overlap weighting based on propensity scores was applied to balance baseline characteristics between sexes. Sex-stratified multivariable analyses were further performed to identify prognostic factors in men and women separately.
RESULTS: There were no significant sex-based differences in OS, CSS, or DFS. In contrast, female patients had significantly better BRFS than male patients on Kaplan-Meier analysis (P < 0.001), and this association remained significant after overlap weighting adjustment. In multivariable analysis, female sex was independently associated with a lower risk of bladder recurrence after RNU (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.46-0.71; P < 0.001). Established adverse prognostic factors for survival outcomes included poor Eastern Cooperative Oncology Group performance status, advanced pathological stage, lymphovascular invasion, and positive surgical margins. Sex-stratified analyses further showed differences in prognostic profiles between men and women across survival endpoints.
CONCLUSIONS: In this large multicenter Taiwanese cohort, sex was not associated with OS, CSS, or DFS after RNU for UTUC. However, female patients had a significantly lower risk of intravesical recurrence, independent of clinicopathological factors. These findings suggest that sex-specific biological or clinical factors may influence bladder recurrence after RNU and support consideration of sex-informed postoperative surveillance strategies.