Gender effect on the oncologic outcomes of upper urinary tract urothelial carcinoma in Taiwan

Purpose: Upper urinary tract urothelial carcinoma (UTUC) is a relatively uncommon malignancy in Western countries, affecting more men than women. By contrast, UTUC is relatively common in Taiwan and diagnosed more often in women than in men. Previous studies regarding the gender effect on cancer behaviour with UTUC have been controversial. Investigation of female predominance of UTUC in Taiwan may help improve UTUC management in Taiwan as well as understand the gender effect on urothelial carcinoma. Methods: Between January 2005 and December 2015, 828 patients with localized UTUC treated with radical nephroureterectomy were enrolled. Cox regression analysis was performed to assess the independent roles of perioperative factors on local recurrence and systemic recurrence. Results: Multivariate analysis revealed the male gender had a trend associated with higher systemic recurrence (P = 0.096) and independently associated with higher bladder recurrence (P = 0.011) and cancer-specific mortality (P = 0.014), even after taking smoking and other established prognostic factors into consideration. Bladder cancer history and multifocal disease are strongly associated with bladder recurrence. Conclusion: Compared with female UTUC patients, male UTUC patients in Taiwan were associated with more bladder recurrences and higher cancer-specific mortality and had a trend associated with more systemic recurrences.