Gender and Menopause Impact on Recurrence and Cancer-Specific Mortality in Bladder Cancer After Radical Cystectomy: A Retrospective Cohort Study
10.22465/juo.255000140007
- Author:
Jee Soo PARK
1
;
Won Sik JANG
;
Jieun HEO
;
Won Sik HAM
;
Kyung Hwan KIM
;
Jong Kil NAM
;
Bum-Jin LIM
;
Bum Sik HONG
;
Wook NAM
;
Sangchul LEE
;
Jong Jin OH
;
Seung Hwan JEONG
;
Ja Hyeon KU
;
Tae Il NOH
;
Sung Gu KANG
;
Seok Ho KANG
;
Yun-Sok HA
;
Tae Gyun KWON
;
Tae‑Hwan KIM
;
Jongchan KIM
;
Geehyun SONG
;
Ho Kyung SEO
;
Wan SONG
;
Hyun Hwan SUNG
;
Byong Chang JEONG
Author Information
1. Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Publication Type:Original Article
- From:
Journal of Urologic Oncology
2025;23(1):88-93
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:Although bladder cancer occurs three to 4 times more frequently in men than in women, the relative number of deaths compared to incidence is higher in women, suggesting that women have a worse prognosis than men. Emerging evidence indicates that the activity of the sex steroid hormone pathway may play a role in bladder cancer development, with demonstrations that both androgens and estrogens have biological effects on bladder cancer in vitro and in vivo. This study investigates the influence of sex and menopausal status on recurrence and cancer-specific death (CSD) in bladder cancer patients undergoing radical cystectomy (RC).
Materials and Methods:This retrospective analysis included 3,913 patients from the Korean Bladder Cancer Study Group Database who underwent RC between 2010 and 2019. Patients were categorized based on gender and menopausal status (≤50 years: premenopausal; >50 years: postmenopausal). Pathological factors, neoadjuvant chemotherapy, recurrence, and CSD rates were analyzed using chi-square and Fisher exact tests.
Results:Among the 3,913 patients, 400 (10.2%) were female. Premenopausal females exhibited significantly lower recurrence rates (28.6%) compared to postmenopausal females (45.7%). CSD rates were similarly reduced in premenopausal females (12.0% vs. 22.2% in postmenopausal females). No significant sex differences in recurrence or CSD were observed among premenopausal patients. Pathological T stage, nodal status, and lymphovascular invasion were significantly associated with recurrence in males, while nodal status alone was significant in females. Neoadjuvant chemotherapy was significantly more frequently administered to male patients under the age of 50, while no difference was observed in the administration of neoadjuvant chemotherapy among female patients based on menopausal status.
Conclusion:Hormonal changes associated with menopause significantly influence bladder cancer outcomes in women. Premenopausal hormonal environments seem protective, underscoring the need for further research into hormone-driven mechanisms in bladder cancer.
