title: Performance status is a predictor of overall survival of elderly patients with muscle invasive bladder cancer.
abstract: OBJECTIVE
  Elderly patients with muscle invasive bladder cancer often present treatment challenges due to concomitant comorbidities and psychosocial factors. This study examines patterns of treatment in this population and evaluates the impact of these factors on overall survival in a contemporary population.
  
  
  METHODS
  Common components of geriatric assessment were reviewed in 152 consecutive patients 70 years old or older presenting with nonmetastatic muscle invasive bladder cancer from January 1995 to December 2004 (median followup of 41 months). Overall survival was evaluated using Kaplan-Meier methods and a multivariate Cox model.
  
  
  RESULTS
  Mean patient age was 76 years. Most patients underwent definitive treatment, with 114 (75%) opting for cystectomy including 29 of 114 (25%) with planned neoadjuvant chemotherapy. Only 15% were treated with palliative intent. Patients with a Karnofsky performance status of 80 or less or prior weight loss underwent bladder preservation more often than cystectomy (p <0.01). Overall survival was greatest in patients 80 years old or older compared to younger cohorts (p = 0.05) and in those treated with bladder preservation compared to other treatments (p = 0.04). In a multivariate analysis patients with a Karnofsky performance status of 80 or less had 1.8 times the risk of death compared to patients with a Karnofsky performance status of 90 or greater (95% CI 1.0-3.2, p = 0.05).
  
  
  CONCLUSIONS
  Most elderly patients with muscle invasive bladder cancer tolerate curative therapy. However, functional status must be seriously considered. Karnofsky performance status is an important predictor of overall survival in this population, with a Karnofsky performance status of 90 or greater providing a significant survival advantage regardless of treatment type. Thus, Karnofsky performance status should be routinely incorporated into treatment planning.
authors: Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, USA.
authors: Alon Z
authors: AZ
authors: Weizer
authors: Daya
authors: D
authors: Joshi
authors: Stephanie
authors: S
authors: Daignault
authors: Michael
authors: M
authors: Kinnaman
authors: Maha
authors: M
authors: Hussain
authors: James E
authors: JE
authors: Montie
authors: Yingzi
authors: Y
authors: Zhang
authors: Cheryl T
authors: CT
authors: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D011379:Prognosis; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000523:psychology / Q000628:therapy