title: Management of elderly patients with urothelial carcinoma of the bladder: guideline concordance and predictors of overall survival.
abstract: OBJECTIVE
  To study guideline recommendation (GR)-concordance rates of treatment in elderly patients with urothelial carcinoma of the bladder (UCB) and to identify predictors of survival.
  
  
  METHODS
  The records of 206 consecutive patients aged ≥ 75 years (median age 79 years; range 75-95) were reviewed. All patients underwent transurethral resection (TUR) or biopsy of UCB. The European Association of Urology and American Urological Association guidelines were used as reference when evaluating concordance with GRs and clinical outcome. Univariable and multivariable analyses were performed to identify predictors of survival.
  
  
  RESULTS
  The overall GR-concordance rate of treatment was 88.8% (183 of 206 patients). Patients who were older (P = 0.017), who underwent prior treatment for UCB (P = 0.010), and had greater comorbidities (P = 0.001) were less likely to undergo treatment following GRs. With a median (mean; range) follow-up of 14.7 (22.6; 0.3-111.5) months, 79 patients died (38.3%). More comorbidities (unadjusted Charlson comorbidity index; P = 0.007), a Karnofsky performance status (KPS) score of ≤ 80 (P = 0.001) and more advanced initial pathological tumour stage (P = 0.019) independently predicted reduced overall survival (OS). In the subgroup of patients with indication for cystectomy (n = 99), there was a trend for longer OS in patients treated with curative intent (cystectomy or radio-chemotherapy) compared with conservative treatment with TUR ± intravesical therapy only (P = 0.095).
  
  
  CONCLUSIONS
  The vast majority of elderly patients with UCB received adequate treatment at our tertiary institution. The KPS score, more comorbidities and more advanced pathological tumour stage are predictors for reduced OS and should be considered to optimize patient care.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Richard
authors.initials: R
authors.lastname: Ho
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Nuss
authors.forename: Nicolas
authors.initials: N
authors.lastname: Ortiz
authors.forename: Ganesh V
authors.initials: GV
authors.lastname: Raj
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*