Advanced age associated with poorer bladder cancer-specific survival in radical cystectomy patients

Traditional wisdom taught in urological residency has been that healthy octogenarians with bladder cancer may be offered radical cystectomy without a significantly increased incidence of postoperative complications.

While these patients may leave the hospital at a reasonable time, however, few studies have specifically evaluated the long-term survival and quality of life of these patients after cystectomy.

In the March issue of European Urology , Nielsen and colleagues from the Bladder Cancer Research Consortium present multi-institutional data evaluating the relationship between patient age, pathological characteristics, and survival in bladder cancer patients after radical cystectomy.

The association between age and disease-specific survival was analyzed as a continuous and categorical variable in a cohort of 888 patients treated with radical cystectomy. Of this group, ages ranged between 70 and 80 years in 266 patients and above 80 years in 51 patients.

Increasing age was associated with a higher risk of extravesical disease and pathological upstaging after cystectomy (p < 0.02). Despite these differences, elderly patients were less likely to receive adjuvant chemotherapy after cystectomy, utilized in 32% of patients 60 years old or younger and in only 14% of patients older than 80 years old (p < 0.01). Disease-specific survival was significantly decreased for elderly patients after adjusting for confounding variables in multivariate analysis including pathologic stage, nodal status, and adjuvant therapy.

These data show that elderly patients exhibit a higher risk of pathologic upstaging after radical cystectomy and are more likely to die of bladder cancer. How do we explain these findings' Are elderly patients more likely to have a delay between the time of diagnosis and cystectomy because of their more extensive preoperative evaluation? Is decreased immune surveillance responsible? An in depth evaluation of these data may result in a re-evaluation of our treatment paradigm for these patients.

Nielsen ME, Shariat SF, Karakiewicz PI, Lotan Y, Rogers CG, Amiel GE, Bastian PJ, Vazina A, Gupta A, Lerner SP, Sagalowsky AI, Schoenberg MP, Palapattu GS, for the Bladder Cancer Research Consortium (BCRC) , Stoeckle M, Brausi MA, Nielsen ME, Palapattu GS, Shariat SF, for the Bladder Cancer Research Consortium

Eur Urol. 51(3):699-708.

By Ricardo Sanchez-Ortiz, MD