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Does Biologic Sex Influence Progression of Bladder Cancer After BCG Treatment?

By: Vanessa A. Carter, BS
Posted: Friday, February 19, 2021

Although women tend to have a lower risk of developing urothelial carcinoma, they often experience a more aggressive and advanced form of the disease. According to Jonathan Fadel, MD, of Centre de recherche CHU de Québec-Université Laval, Canada, and colleagues, there may be a higher incidence of progression and recurrence of non–muscle invasive bladder cancer in female patients following intravesical Bacillus Calmette-Guérin (BCG) treatment when compared to male patients. Their discoveries were presented at the 2020 Annual Meeting of the Society of Urologic Oncology (SUO; Abstract 32).

The researchers focused on 112 women and 418 men with non–muscle invasive bladder cancer treated with intravesical BCG therapy. These patients were identified through pharmacy records with medical chart review to obtain clinical characteristics and outcomes. Multivariable Cox regression and Kaplan-Meier analyses were used to measure recurrence and progression post-BCG treatment.

The median follow-up was 3.7 years. Among the participants, 49.4% of men and 35.7% of women demonstrated pathology-related recurrences. It was determined that women seemed to have a higher risk of recurrence (P = .017) and pathologic progression (P < .001), according to Kaplan-Meier analysis. After the investigators adjusted for smoker status, initial tumor stage, tumor size and grade, multiplicity, and presence of carcinoma in situ, multivariable Cox regression analysis suggested that higher recurrence correlated to female gender (hazard ratio = 1.67).

Furthermore, Cox regression analysis demonstrated that female gender appeared to be linked to a threefold higher risk of disease progression (hazard ratio = 2.96) compared with the male gender. Despite these differences, BCG treatments were observed to be better tolerated in female patients than male patients, with 45% and 31% of participants completing the full protocol, respectively.

Disclosure: The study authors reported no conflicts of interest.

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