(UroToday.com) The 2024 American Urological Association (AUA) annual meeting featured a session on non-invasive bladder cancer, and a presentation by Dr. Giovanni Guano discussing whether intravesical instillations in octogenarian high-grade, non-muscle-invasive bladder cancer patients offer a survival advantage.
Along with the general population, the bladder population is also becoming more elderly. As such, the objective of this study presented at AUA 2024 was to analyze survival outcomes of octogenarian patients with high-grade non-muscle-invasive bladder cancer treated either with intravesical therapy or surveillance.
This study retrospectively analyzed patients aged ≥80 treated with transurethral resection of the bladder and diagnosed with high-grade non-muscle-invasive bladder cancer from a single academic institution from 2016 to 2020. Patients were treated with either intravesical instillation or surveillance. Descriptive statistics analyzed differences in perioperative characteristics, smoothed Poisson regression plots depicted cancer-specific mortality and other-cause mortality, and Kaplan-Meier plots depicted recurrence-free survival according to treatment. Cumulative incidence plots and univariable competing-risks regression models were used to analyze differences in cancer-specific mortality and other-cause mortality among patients managed by surveillance vs intravesical instillations (either mitomycin C or BCG).
Overall, there were 121 patients included in this study with a median age of 84 (IQR 81-87), of which 15 (12%) were females. There were 74 (61%) patients who had a first diagnosis of bladder cancer, and 59 (49%) had multifocal disease. At presentation, 33 (27%) had a tumor size ≥3 cm. Intermediate, high, and very-high EAU non-muscle-invasive bladder cancer risk was present in 17 (14%), 82 (68%), and 22 (18%) patients, respectively. After diagnosis of non-muscle-invasive bladder cancer, 80 (66%) patients were surveilled, 24 (20%) were treated with BCG, 17 (14%) with mitomycin C. Over a median follow-up of 60 months, the overall, 5-year cancer-specific mortality rate was 9% and the 5-year other-cause mortality rate was 50%:
Overall, 44 (36%) patients recurred within 10 months, with a recurrence rate for patients under the surveillance of 38% (30 patients) versus 38% (9 patients) for BCG versus 29% (5 patients) mitomycin C. Cumulative incidence plots and univariable competing-risks regression models revealed no difference in 5-year cancer specific mortality rates in surveillance versus intravesical instillations (9.6% vs 10%, HR 1.09, 95% CI 0.33 - 3.65, p = 0.90), as well as in other-cause mortality rates (57% vs 35%, HR 0.66, 95% CI 0.39 - 0.12, p = 0.10).
Dr. Guano concluded his presentation discussing whether intravesical instillations in octogenarian high-grade, non-muscle-invasive bladder cancer patients offer a real survival advantage with the following take-home messages:
- Mortality in octogenarian patients with high-grade non-muscle-invasive bladder cancer is mostly attributable to other-cause mortality
- This study suggests that, in those patients, intravesical instillations do not seem to provide an oncological survival benefit
- Induction and maintenance with BCG and mitomycin C should therefore be carefully considered as a treatment in elderly patients
Presented by: Giovanni Guano, Policlinico San Martino Hospital, University of Genova, Genova, Italy
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.