Geschlechtsspezifische Unterschiede urologischer Tumore

Zusammenfassung

Geschlechtsunterschiede in der Medizin spielen mittlerweile eine nicht mehr wegzudenkende Rolle, sowohl in Diagnostik als auch Therapie. Risikofaktoren und Mortalität variieren je nach Geschlecht, Krankheiten äußern sich unterschiedlich. In der Diagnostik müssen je nach Geschlecht unterschiedliche Aspekte in Betracht gezogen werden. Bei Blasenkarzinomen zum Beispiel kommt es bei Frauen häufig zu Verzögerungen bei der Diagnose, weil Hämaturie oft benignen Erkrankungen wie Harnwegsinfekten zugeschrieben wird.
Bei Therapieentscheidungen sollte das Geschlecht ebenso eine Rolle spielen. Um ein Beispiel zu nennen, haben Immuncheckpoint-Inhibitoren bei Nierenzellkarzinomen bei Männern ein besseres Ansprechen als bei Frauen. Auch die Outcomes nach onkologischer Therapie bei urologischen Tumoren variieren nach Geschlecht.

Abstract

Gender differences in medicine are playing an increasingly important role in diagnostic testing as well as therapy choices. Risk factors and mortality vary depending on gender. Diseases often manifest differently depending on gender. In diagnostic testing, gender-specific aspects need to be taken into consideration. For instance, bladder cancer diagnosis is often delayed in women compared to men as haematuria is frequently attributed to benign conditions like urinary tract infections. In therapy, decisive gender disparities should also be considered. To state an example, immune-checkpoint inhibitors have shown better response in men than in women when treating renal cell carcinoma. Furthermore, outcomes after treatment for urological tumours differ depending on gender.

Schlüsselwörter

Geschlechtsunterschiede - Urologische Tumore - Urothelkarzinom

Keywords

Gender Differences - Urological Tumors - Urothelial Cancer

Publikationsverlauf

Eingereicht: 05. November 2024

Angenommen nach Revision: 04. März 2025

Artikel online veröffentlicht:
03. April 2025

• Literatur

• 1 Bray F. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424
• 2 Burger M. et al. Epidemiology and risk factors of urothelial bladder cancer. Eur Urol 2013; 63: 234-41
• 3 Pallauf M. et al. A Systematic Review and Meta-Analysis of Prognostic Nomograms After UTUC Surgery. Front Oncol 2022; 12
• 4 Sung H. et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71: 209-249
• 5 WHO. International Agency for Research on Cancer. Cancer tomorrow. 2023 https://gco.iarc.fr/tomorrow/en
• 6 Jemal A. et al. Cancer statistics, 2008. CA Cancer J Clin 2008; 58: 71-96
• 7 Ferlay J. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: E359-E386
• 8 Waldhoer T. et al. Sex Differences of ≥ pT1 Bladder Cancer Survival in Austria: A Descriptive, Long-Term, Nation-Wide Analysis Based on 27,773 Patients. Urol Int 2015; 94: 383-389
• 9 Antoni S. et al. Bladder Cancer Incidence and Mortality: A Global Overview and Recent Trends. Eur Urol 2017; 71: 96-108
• 10 Radkiewicz C. et al. Sex Differences in Urothelial Bladder Cancer Survival. Clin Genitourin Cancer 2020; 18: 26-34.e6
• 11 Torre LA. et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87-108
• 12 Scosyrev E. et al. Sex and racial differences in bladder cancer presentation and mortality in the US. Cancer 2009; 115: 68-74
• 13 Fajkovic H. et al. Impact of gender on bladder cancer incidence, staging, and prognosis. World J Urol 2011; 29: 457-463
• 14 Kluth LA. et al. Gender-specific differences in clinicopathologic outcomes following radical cystectomy: an international multi-institutional study of more than 8000 patients. Eur Urol 2014; 66: 913-919
• 15 Lucca I. et al. Gender differences in incidence and outcomes of urothelial and kidney cancer. Nat Rev Urol 2015; 12: 585-592
• 16 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66: 7-30
• 17 Poli C. et al. Sex differences in muscle-invasive bladder cancers: a study of a French regional population. Fr J Urol 2024; 35
• 18 Palou J. et al. Female gender and carcinoma in situ in the prostatic urethra are prognostic factors for recurrence, progression, and disease-specific mortality in T1G3 bladder cancer patients treated with bacillus Calmette-Guérin. Eur Urol 2012; 62: 118-125
• 19 Fernandez-Gomez J. et al. Prognostic factors in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin: multivariate analysis of data from four randomized CUETO trials. Eur Urol 2008; 53: 992-1001
• 20 Mungan NA. et al. Gender differences in stage distribution of bladder cancer. Urology 2000; 55: 368-371
• 21 Freedman ND. et al. Association between smoking and risk of bladder cancer among men and women. JAMA 2011; 306: 737-745
• 22 Kuper H, Boffetta P, Adami HO. Tobacco use and cancer causation: association by tumour type. J Intern Med 2002; 252: 206-224
• 23 Volanis D. et al. Environmental factors and genetic susceptibility promote urinary bladder cancer. Toxicol Lett 2010; 193: 131-137
• 24 Stewart SL. et al. Surveillance for cancers associated with tobacco use--United States 1999–2004. MMWR Surveill Summ 2008; 57: 1-33
• 25 Strope SA, Montie JE. The causal role of cigarette smoking in bladder cancer initiation and progression, and the role of urologists in smoking cessation. J Urol 2008; 180: 31-37
• 26 Jacob L. et al. Impact of tobacco smoking on the risk of developing 25 different cancers in the UK: a retrospective study of 422,010 patients followed for up to 30 years. Oncotarget 2018; 9: 17420-17429
• 27 Ide H, Inoue S, Miyamoto H. Histopathological and prognostic significance of the expression of sex hormone receptors in bladder cancer: A meta-analysis of immunohistochemical studies. PLoS One 2017; 12
• 28 Dobruch J. et al. Gender and Bladder Cancer: A Collaborative Review of Etiology, Biology, and Outcomes. Eur Urol 2016; 69: 300-310
• 29 Mori K. et al. Impact of sex on outcomes after surgery for non-muscle-invasive and muscle-invasive bladder urothelial carcinoma: a systematic review and meta-analysis. World J Urol 2023; 41: 909-919
• 30 Martin-Doyle W. et al. Improving selection criteria for early cystectomy in high-grade t1 bladder cancer: a meta-analysis of 15,215 patients. J Clin Oncol 2015; 33: 643-650
• 31 Uhlig A. et al. Gender-specific Differences in Recurrence of Non-muscle-invasive Bladder Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus 2018; 4: 924-936
• 32 Kluth LA. et al. Female gender is associated with higher risk of disease recurrence in patients with primary T1 high-grade urothelial carcinoma of the bladder. World J Urol 2013; 31: 1029-1036
• 33 D'Andrea D. et al. Association of patients' sex with treatment outcomes after intravesical bacillus Calmette-Guérin immunotherapy for T1G3/HG bladder cancer. World J Urol 2021; 39: 3337-3344
• 34 Shang Z. et al. Targeting estrogen/estrogen receptor alpha enhances Bacillus Calmette-Guérin efficacy in bladder cancer. Oncotarget 2016; 7: 27325-27335
• 35 May M. et al. Gender-dependent cancer-specific survival following radical cystectomy. World J Urol 2012; 30: 707-713
• 36 Messer JC. et al. Female gender is associated with a worse survival after radical cystectomy for urothelial carcinoma of the bladder: a competing risk analysis. Urology 2014; 83: 863-867
• 37 Zietman AL. et al. Organ conservation in invasive bladder cancer by transurethral resection, chemotherapy and radiation: results of a urodynamic and quality of life study on long-term survivors. J Urol 2003; 170: 1772-1776
• 38 Philipps L. et al. Differences in Quality of Life and Toxicity for Male and Female Patients following Chemo(radiotherapy) for Bladder Cancer. Clin Oncol (R Coll Radiol) 2023; 35: e336-e343
• 39 Witjes JA. et al. Updated 2016 EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. Eur Urol 2017; 71: 462-475
• 40 Zargar H. et al. Multicenter assessment of neoadjuvant chemotherapy for muscle-invasive bladder cancer. Eur Urol 2015; 67: 241-249
• 41 Rose TL. et al. Sex disparities in use of chemotherapy and survival in patients with advanced bladder cancer. Cancer 2016; 122: 2012-2020
• 42 Konety BR, Joslyn SA. Factors influencing aggressive therapy for bladder cancer: an analysis of data from the SEER program. J Urol 2003; 170: 1765-1771
• 43 Krimphove MJ. et al. Sex-specific Differences in the Quality of Treatment of Muscle-invasive Bladder Cancer Do Not Explain the Overall Survival Discrepancy. Eur Urol Focus 2021; 7: 124-131
• 44 Uhlig A. et al. Gender Specific Differences in Disease-Free, Cancer Specific and Overall Survival after Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis. J Urol 2018; 200: 48-60
• 45 D'Andrea D. et al. Impact of sex on response to neoadjuvant chemotherapy in patients with bladder cancer. Urol Oncol 2020; 38: 639.e1-639.e9
• 46 Cerrato C. et al. Effect of Sex on the Oncological Outcomes in Response to Immunotherapy and Antibody-drug Conjugates in Patients with Urothelial and Kidney Cancer: A Systematic Review and a Network Meta-analysis. Eur Urol Oncol 2024; 7: 1005-1014
• 47 Yanagisawa T. et al. Impact of sex on the efficacy of immune checkpoint inhibitors in kidney and urothelial cancers: a systematic review and meta-analysis. World J Urol 2023; 41: 1763-1774
• 48 Farber NJ. et al. Disparities in the Use of Continent Urinary Diversions after Radical Cystectomy for Bladder Cancer. Bladder Cancer 2018; 4: 113-120
• 49 von Deimling M. et al. Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges-a narrative review. Transl Androl Urol 2022; 11: 1598-1610
• 50 Groeben C. et al. Urinary Diversion After Radical Cystectomy for Bladder Cancer: Comparing Trends in the US and Germany from 2006 to 2014. Ann Surg Oncol 2018; 25: 3502-3509
• 51 Bhatt A. et al. Neurovascular preservation in orthotopic cystectomy: impact on female sexual function. Urology 2006; 67: 742-745
• 52 Zippe CD. et al. Female sexual dysfunction after radical cystectomy: a new outcome measure. Urology 2004; 63: 1153-1157
• 53 Anderson CB. et al. Voiding function in women with orthotopic neobladder urinary diversion. J Urol 2012; 188: 200-204
• 54 Finley DS. et al. Urinary retention after orthotopic neobladder substitution in females. J Urol 2011; 186: 1364-1369
• 55 Singla N. et al. A Multi-Institutional Comparison of Clinicopathological Characteristics and Oncologic Outcomes of Upper Tract Urothelial Carcinoma in China and the United States. J Urol 2017; 197: 1208-1213
• 56 Mori K. et al. Differential Effect of Sex on Outcomes after Radical Surgery for Upper Tract and Bladder Urothelial Carcinoma: A Systematic Review and Meta-Analysis. J Urol 2020; 204: 58-62
• 57 Zimmermann K. et al. Health-related quality of life in bladder cancer patients: general and cancer-specific instruments. Part 1. Curr Opin Urol 2021; 31: 297-303
• 58 Catto JWF. et al. Quality of Life After Bladder Cancer: A Cross-sectional Survey of Patient-reported Outcomes. Eur Urol 2021; 79: 621-632
• 59 Grobet-Jeandin E. et al. Health-related quality of life after curative treatment for muscle-invasive bladder cancer. Nat Rev Urol 2023; 20: 279-293