(UroToday.com) The 2024 American Urological Association (AUA) annual meeting featured a session on invasive bladder cancer, and a presentation by Dr. Yannic Volz discussing defining an age-related threshold for an orthotopic neobladder after radical cystectomy.
Radical cystectomy with ileal orthotopic neobladder may negatively affect the patient's health-related quality of life in the long term. Increased age at the time of ileal orthotopic neobladder may also have a negative impact on health-related quality of life. Unfortunately, there is little help from the guidelines regarding selecting patients for orthotopic neobladder:
- AUA Guideline Statement 13: In patients undergoing radical cystectomy, ileal conduit, continent cutaneous, and orthotopic neobladder urinary diversions should all be discussed (Clinical Principle)
- EAU 7.3.6.1: For the choice of urinary diversion, comorbidity, cardiac, pulmonary, and cognitive function are important factors that should be considered, along with the patient’s social support and preference. Age >80 years is often considered to be the threshold after which neobladder reconstruction is not recommended. However, there is no exact age for a strict contraindication. Randomized controlled trials comparing conduit diversion with neobladder or continent cutaneous diversion have not been performed
What we know is that increasing age is a pivotal factor influencing short-term and long-term complications after radical cystectomy, and increasing age may influence continence rates after orthotopic neobladder. As such, Dr. Volz and colleagues aimed to determine a data-based optimal age threshold at the time of radical cystectomy with ileal orthotopic neobladder, after which health-related quality of life worsens.
This study retrospectively analyzed all bladder cancer patients that fulfilled the EORTC QLQ-C30 questionnaire preoperatively and at 3 months, as well as 12 months after radical cystectomy with ileal orthotopic neobladder at the investigator’s institution between 2013 and 2021. General health status (GHS-score) was calculated according to EORTC QLQ-C30 guidelines, and patients receiving adjuvant chemotherapy or palliative radical cystectomy were excluded. The goal was to define an age-related cutoff after which health-related quality of life/GHS score worsens.
Overall, there were 120 patients included (mean age 66 ± 9.6 years) undergoing radical cystectomy with ileal orthotopic neobladder. Their GHS-score preoperatively was 64 ± 23, at three months postoperatively 64 ± 20, and at twelve months 68 ± 23. The baseline characteristics of the patients in the study are as follows:
Overall, 80 (67%) patients presented an increase in the GHS-score at twelve months compared to their preoperative values. Interestingly, the International Consultation on Incontinence Questionnaire did not present statistically significant differences between patients with an increase of the GHS-score at twelve months versus those with decrease of the GHS-score at twelve months (2.5 ± 3.2 versus 2.8 ± 3.5, p = 0.57, respectively). Using ROC analysis with Youden’s index, the authors defined a threshold of 70 years, after which radical cystectomy with ileal orthotopic neobladder leads to worse GHS-score at twelve months postoperatively. Applying this threshold, there were no significant differences in health-related quality of life:
Dr. Volz concluded his presentation discussing defining an age-related threshold for an orthotopic neobladder after radical cystectomy with the following take-home messages:
- After 70 years of age, radical cystectomy with orthotopic neobladder might lead to decreased health-related quality of life/GHS scores
- The decrease in health-related quality of life might be secondary to the increasing rate of incontinence
- Age is only one factor of many that needs to be taken into consideration
Presented by: Yannic Volz, MD, Urologist, University Hospital, LMU Munich, Munich, Germany
Written by: Zachary Klaassen, MD, MSc - Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 American Urological Association (AUA) Annual Meeting, San Antonio, TX, Fri, May 3 - Mon, May 6, 2024.