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05-10-2015 | Genitourinary cancers | Article

Gender differences in incidence and outcomes of urothelial and kidney cancer

Authors:
Ilaria Lucca, Tobias Klatte, Harun Fajkovic, Michela de Martino, Shahrokh F. Shariat

Abstract

A gender discrepancy exists in the incidence of both urothelial and kidney carcinomas, with more men presenting with these cancers than women. Men have a threefold greater risk of developing bladder cancer than women, but female gender has been identified as an independent adverse prognostic factor for both recurrence and progression of this disease. In particular, women with bladder cancer are often diagnosed with a higher tumour stage than men. Conclusive data on the influence of gender on outcomes of patients with upper tract urothelial carcinoma are currently lacking, although men seem to have a higher disease incidence, whereas survival outcomes might be independent of gender. Patients with renal cell carcinoma are more often men and they typically have larger tumours and higher stage and grade disease than women with this cancer. Smoking habits, tumour biology, occupational risk factors and sex steroid hormones and their receptors could have a role in these observed gender disparities. The majority of data support the theory that gender influences incidence and prognosis of urothelial and kidney cancers; men and women are different genetically and socially, making the consideration of gender a key factor in the clinical decision-making process. Thus, the inclusion of this variable in validated prognostic tables and nomograms should be discussed as a matter of importance.

Nat Rev Urol 2015; 12: 653. doi:10.1038/nrurol.2015.257

Subject terms: Bladder cancer • Renal cancer • Urological cancer

In the era of modern medicine, the genomic detail of many diseases has been elucidated and has confirmed an obvious truth—men and women are genetically different—but gender differences are often overlooked in clinical practice. In general, two random individuals of the same gender are 99.9% genetically identical; however, the genome of a man and that of a woman are only 98.5% identical,1, 2 a difference of 1.4%. Besides anatomical and hormonal disparities, genetic difference is another factor that make the genders different, especially in the context of disease risks, prognosis and outcomes, and should be considered when assessing the effects of gender on disease incidence, stage, progression, metastases and response to therapy.

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