The effect of age and gender on bladder cancer: a critical review of the literature.
The effect of age and gender on bladder cancer: a critical review of the literature.
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DOI：
10.1111/j.1464-410x.2009.09076.x
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发表时间：
2010-02
影响因子：
4.5
通讯作者：
Bochner BH
中科院分区：
文献类型：
--
作者：
Shariat SF;Sfakianos JP;Droller MJ;Karakiewicz PI;Meryn S;Bochner BH
虽然患者年龄和性别是治疗膀胱尿路上皮癌（UCB）的临床决策的重要因素，但没有循证建议来指导医疗保健专业人员。我们回顾了以往的报告，年龄和性别的影响的发病率，生物学，死亡率和治疗的UCB。使用MEDLINE，我们检索了1966年1月至2009年7月期间发表的既往报告。虽然男性患UCB的可能性是女性的三到四倍，但女性的疾病更严重，生存率更低。性别差异被认为是致癌物（即烟草和化学品）暴露差异的结果，也反映了遗传、解剖、激素、社会和环境因素。住院时间、血尿转诊模式和手术结果表明，对妇女的护理质量低下可能是造成两性不平等的另一个原因。年龄是发展UCB的最大单一风险因素，一旦确诊，就会死于UCB。老年患者在接受适当治疗时面临临床和机构障碍;他们接受的治疗积极性较低，剂量低于治疗剂量。许多证据表明，在确定老年患者对UCB及其治疗的临床和行为反应时，单凭实足年龄是不够的。应鼓励进行流行病学和分子机制研究，以设计、分析和报告与性别和年龄有关的关联。提高非专业人士和医学界对膀胱癌的认识，仔细选择患者，根据个体患者的需求和生理和身体储备量身定制治疗，以及积极的术后护理尤为重要。我们必须努力发展跨学科的合作努力，为UCB患者提供量身定制的性别和年龄特异性护理。
While patient age and gender are important factors in the clinical decision-making for treating urothelial carcinoma of the bladder (UCB), there are no evidence-based recommendations to guide healthcare professionals. We review previous reports on the influence of age and gender on the incidence, biology, mortality and treatment of UCB. Using MEDLINE, we searched for previous reports published between January 1966 and July 2009. While men are three to four times more likely to develop UCB than women, women present with more advanced disease and have worse survival rates. The disparity among genders is proposed to be the result of a differential exposure to carcinogens (i.e. tobacco and chemicals) as well as reflecting genetic, anatomical, hormonal, societal and environmental factors. Inpatient length of stay, referral patterns for haematuria and surgical outcomes suggest that inferior quality of care for women might be an additional cause of gender inequalities. Age is the greatest single risk factor for developing UCB and dying from it once diagnosed. Elderly patients face both clinical and institutional barriers to appropriate treatment; they receive less aggressive treatment and sub-therapeutic dosing. Much evidence suggests that chronological age alone is an inadequate indicator in determining the clinical and behavioural response of older patients to UCB and its treatment. Epidemiological and mechanistic molecular studies should be encouraged to design, analyse and report gender- and age-specific associations. Improved bladder cancer awareness in the lay and medical communities, careful patient selection, treatment tailored to the needs and the physiological and physical reserve of the individual patient, and proactive postoperative care are particularly important. We must strive to develop transdisciplinary collaborative efforts to provide tailored gender- and age-specific care for patients with UCB.