Introduction: Previous literature has demonstrated the existence of gender disparities for urothelial cell carcinoma (UCC) of the bladder including higher stage at presentation in women, higher rates of complications, and worsened survival. Similar outcomes are not well characterized for upper tract urothelial carcinoma (UTUC). Our goal was to analyze patterns of presentation, neoadjuvant chemotherapy (NAC) use and survival outcomes for UTUC across genders. Methods: The National Cancer Database was queried for all patients with UTUC of the renal pelvis from 2004 to 2016 undergoing nephroureterectomy. Patients were stratified based on female or male sex. Demographics, clinical stage and use of NAC were evaluated. Outcomes including 30 and 90 day readmission, positive margins, and mortality were analyzed. Results: 31,411 patients were identified with 58.6% male and 41.4% female. Females were older (72.4 vs 70.1 years, P<0.001), and more likely to be of black race (P <0.001). Males were more likely to have higher Charlson comorbidity scores (P <0.001). Clinical tumor and nodal stage did not vary between men and women, however women were more likely to present with high grade disease (P <0.001). Outcomes including positive margin, 30 day readmission, and all-cause mortality did not differ based on sex. When stratified by pT stage, we found females to have improved median survival time with pT0/1 (99 vs 91 months, P=0.02) but there was no gender difference for median survival with pT2-4 disease or when accounting for all pT stages together (figure). On a subset analysis of patients with high grade disease receiving NAC, we found females were more likely to downstage to pT0 disease (11.2 vs 2.9%, P<0.001) Conclusions: The gender disparities previously reported with UCC of the bladder are not readily evident with UTUC of the renal pelvis. Taken together, this suggests the underlying urothelial histopathology does not contribute to UCC gender disparity; however, unmeasured diagnostic and clinical factors are contributory. SOURCE OF Funding: N/A
