Perioperative mortality is significantly greater in septuagenarian and octogenarian patients treated with radical cystectomy for urothelial carcinoma of the bladder.
OBJECTIVE
To revisit whether the perioperative mortality differs between septuagenarian and octogenarian patients and younger patients in a large contemporary population-based cohort. The data from tertiary care centers have suggested that perioperative mortality after radical cystectomy is not considerably different in septuagenarian or octogenarian patients compared with younger patients. However, population-based data have stated otherwise.


METHODS
From 1988 to 2006, 12,722 radical cystectomies were performed for urothelial carcinoma of the urinary bladder in 17 Surveillance, Epidemiology, and End Results registries. Of those 12,722 patients, 4480 (35.2%) were aged 70-79 years and 1439 (11.3%) were aged ≥80 years. Univariate and multivariate logistic regression models tested the 90-day mortality after radical cystectomy. Covariates consisted of sex, race, year of surgery, Surveillance, Epidemiology, and End Results registry, and histologic grade and stage.


RESULTS
The overall 90-day mortality rate was 4% for the entire population, 2% for patients aged ≤69 years, 5.4% for septuagenarian patients, and 9.2% for octogenarian patients. In the multivariate logistic regression analyses, septuagenarian (odds ratio 2.80; P < .001) and octogenarian (odds ratio 5.02; P < .001) age increased the risk of 90-day mortality after radical cystectomy.


CONCLUSIONS
In the present population-based analysis, the perioperative mortality after radical cystectomy was three- and fivefold greater in the septuagenarian and octogenarian patients, respectively, which was greater than that in tertiary care centers. This information should be included in informed consent considerations.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
Daniel
D
Liberman
Giovanni
G
Lughezzani
Maxine
M
Sun
Ahmed
A
Alasker
Rodolphe
R
Thuret
Firas
F
Abdollah
Lars
L
Budaus
Hugues
H
Widmer
Markus
M
Graefen
Francesco
F
Montorsi
Shahrokh F
SF
Shariat
Paul
P
Perrotte
Pierre I
PI
Karakiewicz
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000601:surgery*; D002423:Cause of Death; D015653:Cystectomy / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000601:surgery*