Background: Urothelial carcinoma (UC) is one of the most common cancers diagnosed worldwide. However, minority populations, such as female, elder, and Black patients, may have disparate outcomes and are commonly neglected in randomized prospective trials. This review aims to study the relationship between age, sex, and race on urothelial cancer prognosis, particularly focusing on contemporary therapy and its effect on overall survival. Methods: Phase III prospective trials since 2016 of immune checkpoint inhibitors, antibody-drug conjugates, or targeted therapies in urothelial carcinoma were identified from PubMed. Trials that did not report on survival by race, sex, or age distribution were excluded, and remaining trials (n= 17) were compared by subgroup. Results: Women were reported to have inferior OS on investigational agents compared to men in 9/17 trials. In a meta-analysis, women had inferior OS to men (OR 0.89 [95% CI: 0.78–0.99];p= 0.04). Asian/Pacific Islander patients had inferior outcomes to White patients on investigational agents in 3/5 trials. In a meta-analysis, OS was not significant by race (OR 1.18 [0.90–1.46],p= 0.38). Black patients composed <2% of all trial patients, and no subgroup data were reported. Both 65 (n= 7) and 75 (n= 2) were reported as age cut-offs in trial subgroups, and survival data were mixed. Conclusions: Women in UC trials may have inferior survival outcomes to men. Racial diversity was poor and thus limited any conclusions on survival disparities.
背景：尿路上皮癌是全球最常见的癌症之一。然而，女性、老年及黑人等少数群体患者的预后可能存在差异，且在随机前瞻性试验中常被忽视。本综述旨在探讨年龄、性别和种族对尿路上皮癌预后的影响，特别关注现代疗法及其对总生存期的作用。方法：通过PubMed检索2016年以来尿路上皮癌免疫检查点抑制剂、抗体偶联药物或靶向治疗的III期前瞻性试验。排除未按种族、性别或年龄分布报告生存数据的试验，对剩余试验（n=17）进行亚组比较。结果：在9/17的试验中，女性接受试验药物治疗的总生存期低于男性。一项荟萃分析显示，女性总生存期显著低于男性（OR 0.89 [95% CI: 0.78–0.99]；p=0.04）。在3/5的试验中，亚裔/太平洋岛民患者接受试验药物治疗的疗效低于白人患者。但荟萃分析显示种族间总生存期无显著差异（OR 1.18 [0.90–1.46]，p=0.38）。黑人患者在所有试验患者中占比不足2%，且无亚组数据报告。试验亚组中分别以65岁（n=7）和75岁（n=2）作为年龄分界点，生存数据结果不一。结论：尿路上皮癌试验中女性患者的生存结局可能劣于男性。种族多样性严重不足，限制了关于生存差异的结论推导。
肿瘤(癌症)患者之家