Impact of patient age on outcome following bladder-preserving treatment for non-muscle-invasive bladder cancer.
OBJECTIVE
To determine the impact of patient age on outcome following bladder-preserving treatment for non-muscle-invasive bladder cancer (NMIBC).


METHODS
This study examined 491 patients treated with transurethral resection and/or intravesical bacillus Calmette-Guerin (BCG) therapy for primary NMIBC at our institution between 1985 and 2005. The patients' age at treatment was classified into categories of younger than 50, 50-59, 60-69, 70-79, and 80 years or older. Recurrence-free survival and progression-free survival were estimated by the Kaplan-Meier method and analyzed using Cox proportional hazard models.


RESULTS
Tumors of broad-based, multiple, and higher grades were more frequent with increasing patient age. Intravesical BCG therapy was less frequently performed on elderly patients. At a median follow-up of 45 months, patients 80 years or older had the lowest recurrence-free survival and progression-free survival among the age groups (log-rank P < 0.001 and P = 0.019, respectively). On Cox proportional hazard model, age was an independent risk factor for tumor recurrence and progression after controlling for all confounding variables. The recurrence risk was 2.3 times higher for patients 80 years or older than those aged 60-69 years (P < 0.001).


CONCLUSIONS
Older age adversely affected the outcome of patients with NMIBC, which is particularly apparent in patients 80 years or older. Further prospective studies to confirm these findings are warranted.
Department of Urology, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan. ykohji@wakayama-med.ac.jp
Yasuo
Y
Kohjimoto
Akinori
A
Iba
Yasuyo
Y
Shintani
Takeshi
T
Inagaki
Yasunari
Y
Uekado
Isao
I
Hara
D000283:Administration, Intravesical; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine; D002291:Carcinoma, Papillary / Q000401:mortality* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D016016:Proportional Hazards Models; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D013520:Urologic Surgical Procedures / Q000379:methods* / Q000401:mortality*; D055815:Young Adult
D001500:BCG Vaccine