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Parker WP, Smelser W, Lee EK, et al. Utilization and Outcomes of Radical Cystectomy for High-grade Non-muscle-invasive Bladder Cancer in Elderly Patients. Clin Genitourin Cancer. 2017;doi: 10.1016/j.clgc.2017.07.011.
Parker, W. P., Smelser, W., Lee, E. K., Habermann, E. B., Thapa, P., Zaid, H. B., Frank, I., Griebling, T. L., Tollefson, M. K., Thompson, R. H., Holzbeierlein, J. M., Karnes, R. J., & Boorjian, S. A. (2017). Utilization and Outcomes of Radical Cystectomy for High-grade Non-muscle-invasive Bladder Cancer in Elderly Patients. Clinical genitourinary cancer, . https://doi.org/10.1016/j.clgc.2017.07.011
Parker, William P, et al. "Utilization and Outcomes of Radical Cystectomy for High-grade Non-muscle-invasive Bladder Cancer in Elderly Patients." Clinical genitourinary cancer vol. (2017). doi: https://doi.org/10.1016/j.clgc.2017.07.011
Parker WP, Smelser W, Lee EK, Habermann EB, Thapa P, Zaid HB, Frank I, Griebling TL, Tollefson MK, Thompson RH, Holzbeierlein JM, Karnes RJ, Boorjian SA. Utilization and Outcomes of Radical Cystectomy for High-grade Non-muscle-invasive Bladder Cancer in Elderly Patients. Clin Genitourin Cancer. 2017 Aug 01; doi: 10.1016/j.clgc.2017.07.011. Epub 2017 Aug 01. PMID: 28844793.
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Clin Genitourin Cancer. 2017 Aug 01; doi: 10.1016/j.clgc.2017.07.011. Epub 2017 Aug 01.

Utilization and Outcomes of Radical Cystectomy for High-grade Non-muscle-invasive Bladder Cancer in Elderly Patients.

Clinical genitourinary cancer

William P Parker, Woodson Smelser, Eugene K Lee, Elizabeth B Habermann, Prabin Thapa, Harras B Zaid, Igor Frank, Tomas L Griebling, Matthew K Tollefson, R Houston Thompson, Jeffrey M Holzbeierlein, R Jeffrey Karnes, Stephen A Boorjian

Affiliations

  1. Department of Urology, Mayo Clinic, Rochester, MN; Department of Urology, University of Kansas Medical Center, Kansas City, KS.
  2. Department of Urology, University of Kansas Medical Center, Kansas City, KS.
  3. Department of Health Services Research, Mayo Clinic, Rochester, MN.
  4. Department of Urology, Mayo Clinic, Rochester, MN.
  5. Department of Urology, University of Kansas Medical Center, Kansas City, KS; The Landon Center on Aging, University of Kansas Medical Center, Kansas City, KS.
  6. Department of Urology, Mayo Clinic, Rochester, MN. Electronic address: [email protected].

PMID: 28844793 DOI: 10.1016/j.clgc.2017.07.011

Abstract

BACKGROUND: Radical cystectomy (RC) represents a treatment option for patients with high-grade non-muscle-invasive bladder cancer (HG-NMIBC); however, perioperative morbidity is not insignificant, particularly in elderly patients. We sought to evaluate the associations of age with utilization and outcomes of RC for HG-NMIBC.

PATIENTS AND METHODS: Patients with HG-NMIBC diagnosed between 2004 and 2013 were identified in the National Cancer Database and stratified by age: ≤ 60, 61-70, 71-80, and > 80 years. Association between age and treatment with RC was assessed by multivariable logistic regression. Associations between age and overall survival were assessed using the Kaplan-Meier method. A multi-institutional analysis was performed to evaluate the associations of age with perioperative outcomes and survival among patients managed with RC for HG-NMIBC.

RESULTS: On multivariable analysis, age was associated with RC utilization, with the lowest usage in patients > 80 years (2.1%; P < .01). Upstaging at RC occurred in 40% of patients with HG-NMIBC, and no association of age with upstaging risk was noted. Significantly inferior overall survival was observed in the patients who were upstaged across age strata (all P < .01). In the multi-institutional cohort, age was not associated with risks of upstaging, receipt of transfusion, 30-/90-day complications, or recurrence-free or cancer-specific survival (all P > .05), whereas upstaging was associated with inferior recurrence-free and cancer-specific survival regardless of age.

CONCLUSION: RC for HG-NMIBC is used less frequently in older adults, despite similar risks of pathologic upstaging. As upstaging is associated with inferior survival regardless of age, these data suggest that elderly patients with HG-NMIBC may be at risk for undertreatment.

Copyright © 2017 Elsevier Inc. All rights reserved.

Keywords: Complications; Outcomes; Practice patterns; Upstaging; Utilization

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