AUA 2017: The Association of Age With Perioperative and Clinicopathologic Outcomes Following Radical Cystectomy for Non-muscle Invasive Bladder Cancer
This was a multi-institutional study, assessing NMIBC patients managed with RC between the years 2000-2013. Patients were initially stratified by age: <70 versus ≥70. Furthermore, multivariate logistic regression analysis was performed analyzing the associations of age with receipt of perioperative blood transfusion (PBT), prolonged operative time (pORT) and prolonged length of stay (pLOS) , RC pathology, and 30/90 day postoperative complications. Recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS) were evaluated as well.
Overall, 489 patients were identified with 263 (55.8%) being younger than 70 and 226 (46.2%) older than 70. On multivariable analysis, age ≥70 was not significantly associated with patients' risk of receipt of a PBT, pORT, pathologic stage pT2-4 or pN+, 30 day or 90 day grade III+ complications. However, pLOS was more likely in older patients (OR 1.77; 95%CI 1.09-2.85; p=0.02). Estimated 5-yr RFS, CSS, and OS in patients <70 versus ≥70 was 70% vs 62% (p=0.14), 84% vs 77% (p=0.06), and 74% vs 54% (p<0.01). On multivariable Cox regression analyses, age ≥70 was not independently associated with RFS or CSS, but remained associated with decreased OS (HR 1.91; 95% CI 1.50-2.45; p<0.01). In all patients, regardless of age, pathologic upstaging was associated with worse RFS, CSS, and OS on all analyses.
In conclusion, older patients with NMIBC had similar risks of pathologic upstaging at RC, and patients upstaged at surgery had worse cancer outcomes across age strata. Importantly, advanced age was not associated with increased risks of PBT, pORT, or perioperative complications. These data support the use of RC for select older patients with high-risk NMIBC.
Presented By: William Parker, Rochester, MN
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA