Curative Treatment for Muscle Invasive Bladder Cancer in Elderly Patients: A Systematic Review

Fonteyne, Valérie; Ost, Piet; Bellmunt, Joaquim; Droz, Jean Pierre; Mongiat-Artus, Pierre; Inman, Brant A.; Paillaud, Éléna; Saad, Fred; Ploussard, Guillaume

doi:10.1016/j.eururo.2017.03.019

Cited by 112 publications

(78 citation statements)

References 69 publications

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“…Elderly BLCA patients have increased genetic aberrations and tend to exhibit a poor-differentiated histology and a more aggressive phenotype. 41 Elderly BLCA patients often receive a delayed diagnosis and have more comorbidities than young patients. Our results support this theory, but more details about differences in the genetic aberrations between elderly and young BLCA patients should be studied.…”

Section: Discussionmentioning

confidence: 99%

An EMT‐related gene signature for the prognosis of human bladder cancer

Cao

Yuan

et al. 2019

J Cellular Molecular Medi

152

120

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The transition from non–muscle‐invasive bladder cancer (NMIBC) to muscle‐invasive bladder cancer (MIBC) is detrimental to bladder cancer (BLCA) patients. Here, we aimed to study the underlying mechanism of the subtype transition. Gene set variation analysis (GSVA) revealed the epithelial‐mesenchymal transition (EMT) signalling pathway with the most positive correlation in this transition. Then, we built a LASSO Cox regression model of an EMT‐related gene signature in BLCA. The patients with high risk scores had significantly worse overall survival (OS) and disease‐free survival (DFS) than those with low risk scores. The EMT‐related gene signature also performed favourably in the accuracy of prognosis and in the subtype survival analysis. Univariate and multivariate Cox regression analyses demonstrated that the EMT‐related gene signature, pathological N stage and age were independent prognostic factors for predicting survival in BLCA patients. Furthermore, the predictive nomogram model was able to effectively predict the outcome of BLCA patients by appropriately stratifying the risk score. In conclusion, we developed a novel EMT‐related gene signature that has tumour‐promoting effects, acts as a negative independent prognostic factor and might facilitate personalized counselling and treatment in BLCA.

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Section: Discussionmentioning

confidence: 99%

An EMT‐related gene signature for the prognosis of human bladder cancer

Cao

Yuan

et al. 2019

J Cellular Molecular Medi

152

120

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“…RC along with pelvic lymph node dissection and urinary diversion represents the gold standard for the treatment of patients with muscle-invasive and recurrent high-risk non-muscle-invasive bladder cancer [14]. Despite the standardization of surgical techniques and the introduction of robotic laparoscopy, RC is still among the most complex procedures with multiple risks of postoperative complications and is performed mostly in older patients [6,15]. Complication rates range between 50% and 60% within 90 days, and readmission rates vary from 20% to 30% within 30 days, both of which are among the highest rates among major cancer surgeries [16,17].…”

Section: Discussionmentioning

confidence: 99%

Implementation of enhanced recovery after surgery in patients undergoing radical cystectomy: A retrospective cohort study

Zhang

Zhu

et al. 2020

European Journal of Surgical Oncology

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“…Although the quite favorable oncological outcomes in the overall cohort (intention‐to‐treat analysis) might be explained in part by the fact that most patients were medically fit for definitive surgery, but strongly desired bladder preservation, we believe that all MIBC patients who meet the inclusion criteria could be candidates for bladder preservation with TeMT. Deciding an optimal treatment for elderly patients with MIBC is challenging . Previous studies have shown an increased risk of perioperative complications and mortality with RC, and decreased use of definitive therapy in elderly patients .…”

Section: Discussionmentioning

confidence: 99%

Feasibility and outcomes of selective tetramodal bladder‐preservation therapy in elderly patients with muscle‐invasive bladder cancer

et al. 2020

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Objective To assess the feasibility and functional/oncological outcomes of selective tetramodal bladder‐preservation therapy in elderly patients with muscle‐invasive bladder cancer. Methods This study analyzed 154 patients with non‐metastatic muscle‐invasive bladder cancer who were enrolled into the protocol. After maximal transurethral resection and induction chemoradiotherapy, patients with clinical complete response were offered consolidative partial cystectomy to achieve bladder preservation; otherwise, radical cystectomy was recommended. Postoperative complications, preserved bladder function, and oncological outcomes were compared between elderly (aged ≥75 years) and younger patients (aged <75 years). Frailty and sarcopenia were further assessed as potential factors that could affect the feasibility and outcomes of the protocol. Results A total of 44 patients (29%) were elderly, and 31 (20%) were frail (modified frailty index 2–3). Sarcopenia was observed in 68 (54%) of 126 eligible patients. Clinical complete response to induction chemoradiotherapy was achieved in 125 (81%) patients, and the bladder‐preservation protocol was completed in 107 (69%) patients with consolidative partial cystectomy. Over a median follow‐up period of 48 months, 5‐year cancer‐specific and muscle‐invasive bladder cancer recurrence‐free survival rates after protocol completion were 98% and 95%, respectively. There were no significant differences in complication rates related to partial cystectomy, preserved bladder function, and oncological outcomes between the elderly and younger groups. Neither frailty nor sarcopenia negatively affected these outcomes. Conclusions Tetramodal bladder‐sparing therapy incorporating consolidative partial cystectomy is feasible and yielded favorable functional/oncological outcomes in patients with muscle‐invasive bladder cancer, regardless of advanced age, frailty or sarcopenia. This protocol could be a viable treatment option for such high‐risk patient populations.

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Curative Treatment for Muscle Invasive Bladder Cancer in Elderly Patients: A Systematic Review

Cited by 112 publications

References 69 publications

An EMT‐related gene signature for the prognosis of human bladder cancer

An EMT‐related gene signature for the prognosis of human bladder cancer

Implementation of enhanced recovery after surgery in patients undergoing radical cystectomy: A retrospective cohort study

Feasibility and outcomes of selective tetramodal bladder‐preservation therapy in elderly patients with muscle‐invasive bladder cancer

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