Introduction

Upper tract urothelial carcinoma (UTUC) show heterogeneous outcome after nephroureterectomy (NU). Despite gender-specific differences, no comparative studies exist for this tumor. The aim of this investigation was to describe tumor characteristics, and survival in patients with UTUC in a multicenter-based cohort, with special reference to gender-related differences.

Methods

Cancer-specific survival (CSS) of 1304 UTUC patients without neoadjuvant chemotherapy staged any pT, pN0-1, M0 after NU were analyzed in a retrospective multicenter study. Median follow-up period was 34 months. The influence of different clinical and histopathologic variables on CSS was determined through uni- and multi-variate Cox regression analyses.

Results

In total, 916 (70.2%) patients were male and 388 (29.8%) were female. Compared to men, women were more likely to have advanced tumor stages (p = 0.007), higher grade (p < 0.001) and lympho-vascular invasion (LVI) (p < 0.001). There was statistical difference in disease recurrence and cancer-specific survival between both genders when analyzed as a group. In LVI status-adjusted analyses, women without LVI were more likely to die of UTUC compared to the male counterparts (p = 0.011). Logistic regression modeling, female gender (HR = 1.42, p = 0.037), LVI (HR = 1.61, p = 0.004), and ECOG performance status (HR = 1.47, p = 0.007) significantly worsened cancer specific deaths. In gender-specific multivariable analyses that adjusted for standard clinico-pathologic features, positive urine cytology at diagnosis (p = 0.001), tumor grade (p = 0.007), LVI (p = 0.005), and pathologic tumor stage (p < 0.001) were independent predictors for CSS.

Conclusions

In this multicenter-based cohort, female gender was associated with inferior cancer-specific and relative survival. Women present with more aggressive tumor biologic features at NU, this translated into inferior outcomes compared to men in LVI-specific analyses in our cohort. Positive urine cytology at diagnosis, tumor grade, LVI, and pathologic tumor stage, were the factors influencing the course of disease in both genders.

Funding

none