The prognostic significance of advanced age in patients with bladder cancer treated with radical cystectomy

Abstract

OBJECTIVETo evaluate the association of patient age with pathological and long‐term oncological outcomes after radical cystectomy (RC) for bladder carcinoma, as this disease, like many others, increases in incidence with age.PATIENTS AND METHODSWe retrospectively reviewed 241 consecutive patients with invasive bladder cancer who had RC between 1990 and 2007. The age at RC was analysed both as a continuous and categorical (≤50 years, 38 patients; 51–69, 172; or ≥70, 31) variable. Survival was also analysed.RESULTSIncreasing age, analysed as a continuous and categorical variable, was associated with advanced pathological stage (P = 0.009 and 0.006, respectively). The 5‐year cancer‐specific survival rates for patients according to the age groups were 78.5%, 44.9% and 28.1%, respectively, and Kaplan‐Meier analysis showed an increased risk of bladder cancer‐specific death with advancing age (P < 0.001). Being older at RC was an important prognostic factor for disease‐specific survival in a multivariate Cox regression model. Patients aged ≥70 years had a significantly higher risk of disease than patients aged ≤50 years (P = 0.002).CONCLUSIONSHigher age at RC is significantly associated with the risk of pathologically advanced disease and poorer cancer‐specific survival. More prospective work is needed to examine the impact of age on tumour biology and cancer‐specific survival.

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“…In contrast, previous studies have shown 46%-55% rates of noneorgan-confined disease in elderly patients. 4,25 Conversely, fewer patients were found to have superficial or absent disease at cystectomy in this cohort than in previous studies. In the elderly, Nielsen et al 4 showed that 32% of cystectomy specimens harbored noninvasive disease.…”

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“…It is reported that the tumor is more differentiated and less aggressive in bladder tumor patients younger than 40 years of age (28,29). In addition, other studies reported decreased recurrence and progression rates in younger patients as well (28,29,30,31,32). As opposed to this, there are also other studies that showed no significant difference between age (33,34,35).…”

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