Gender differences in prevalence, tumor invasiveness, response to treatment, and clinical outcomes exist in different types of cancer. The aim of this article is to summarize the sex disparities in bladder cancer diagnosis and treatment and try to suggest areas for improvement. Although men are at a higher risk of developing bladder tumors, women tend to be diagnosed with more advanced stages at diagnosis and are more likely to present with upfront muscle-invasive disease. Non-urothelial histological subtypes are more frequently reported in women. Regarding non-muscle-invasive bladder cancer (NMIBC), several studies have shown that women have a higher risk of disease recurrence after treatment with Bacillus Calmette–Guerin, due to different immunogenicities. In localized muscle-invasive bladder cancer (MIBC), neoadjuvant chemotherapy and cystectomy are less likely to be performed on women and sexual-sparing procedures with neobladder diversion are rarely offered. Finally, women appear to have a poorer prognosis than men, potentially due to the sex-associated intrinsic features of hosts and tumors that may drive differential therapeutic responses, particularly to immune-based therapies. Women are also more likely to develop severe adverse events related to systemic therapies and are underrepresented in randomized studies, leading to a gap between the real world and trials. In conclusion, studies investigating the role of sex and gender are urgently needed to improve the management of urothelial carcinoma.
在不同类型的癌症中，性别差异体现在患病率、肿瘤侵袭性、治疗反应及临床结局等多个方面。本文旨在总结膀胱癌诊断与治疗中存在的性别差异，并尝试提出改进方向。尽管男性罹患膀胱肿瘤的风险更高，但女性在确诊时往往处于更晚期阶段，且更易出现初诊即为肌层浸润性病变的情况。非尿路上皮组织学亚型在女性中更为常见。针对非肌层浸润性膀胱癌（NMIBC），多项研究表明由于免疫原性差异，女性在接受卡介苗治疗后疾病复发风险更高。在局限性肌层浸润性膀胱癌（MIBC）治疗中，女性接受新辅助化疗及膀胱切除术的可能性较低，且极少获得保留性功能的新膀胱重建手术机会。最终，女性预后普遍差于男性，这可能源于宿主与肿瘤内在的性别相关特征导致治疗反应差异，尤其对免疫疗法的影响更为显著。此外，女性更易出现全身治疗相关的严重不良事件，且在随机研究中代表性不足，导致真实世界数据与临床试验结果存在差距。综上所述，亟需开展针对性别因素影响的研究，以优化尿路上皮癌的临床管理策略。
肿瘤(癌症)患者之家