Introduction: To assess gender-specific differences in recurrence-free (RFS), progression-free (PFS), cancer-specific survival (CSS) and overall survival (OS) among patients with intermediate or high-risk non-muscle invasive bladder cancer (NMIBC) receiving BCG is the primary aim of this systematic review and meta-analysis. Methods: In July 2023, we performed a literature search using MEDLINE, Embase and Cochrane Library. This study was prospectively registered at PROSPERO (CRD 2023443269). The detailed review protocol is accessible via CRD. Results: The systematic literature search identified 6,723 studies, of which 38 fulfilled the inclusion criteria. Random effect meta-analysis for RFS, based on data from 24 studies, revealed no statistically significant gender-specific difference (HR comparing males to females=0.9618, 95% CI: 0.8408-1.1003, p=0.5707). Similarly, for PFS, incorporating data from 14 studies, no statistically significant difference (HR =0.9540, 95% CI: 0.7709- 1.1805, p=0.6648), for CSS, analysis of data from three studies yielded no statistically significant difference (HR =0.9228, 95% CI: 0.6196-1.3743, p=0.6925), and for OS, based on data from two studies, no statistically significant difference was observed (HR = 1.1436, 95% CI: 0.5092-2.5684, p=0.7452). The risk of bias assessment indicated an overall moderate to high risk of bias. Conclusion: The findings indicate no association between gender and oncologic outcomes following BCG.

Gender-specific differences in recurrence and progression following BCG instillation for NMIBC