title: [Influence of older age on survival after radical cystectomy due to urothelial carcinoma of the bladder: survival analysis of a German multi-centre study after curative treatment of urothelial carcinoma of the bladder].
abstract: BACKGROUND
  The therapeutic gold standard of muscle-invasive tumour stages is radical cystectomy (RC), but there are still conflicting reports about associated morbidity and mortality and the oncologic benefit of RC in elderly patients. The aim of the present study was the comparison of overall (OS) and cancer-specific survival (CSS) in patients <75 and >75 years of age (median follow-up was 42 months).
  
  
  METHODS
  Clinical and histopathological data of 2,483 patients with urothelial carcinoma and consecutive RC were collated. The study group was dichotomized by the age of 75 years at RC. Statistical analyses comprising an assessment of postoperative mortality within 90 days, OS and CSS were assessed. Multivariate logistic regression and survival analyses were performed.
  
  
  RESULTS
  The 402 patients (16.2%) with an age of ≥75 years at RC showed a significantly higher local tumour stage (pT3/4 and/or pN+) (58 vs 51%; p=0.01), higher tumour grade (73 vs 65%; p=0.003) and higher rates of upstaging in the RC specimen (55 vs 48%; p=0.032). Elderly patients received significantly less often adjuvant chemotherapy (8 vs 15%; p<0.001). The 90-day mortality was significantly higher in patients ≥75 years (6.2 vs 3.7%; p=0.026). When adjusted for different variables (gender, tumour stage, adjuvant chemotherapy, time period of RC), only in male patients and locally advanced tumour stages was an association with 90-day mortality noticed. The multivariate analysis showed that patients ≥75 years of age have a significantly worse OS (HR=1.42; p<0.001) and CSS (HR=1.27; p=0.018).
  
  
  CONCLUSIONS
  An age of ≥75 years at RC is associated with a worse outcome. Prospective analyses including an assessment of the role of comorbidity and possibly age-dependent tumour biology are warranted.
authors.affiliation: Urologische Klinik, St. Elisabeth Klinikum Straubing, St. Elisabeth-Straße 23, 94315 Straubing, Deutschland. matthias.may@klinikum-straubing.de
authors.forename: M
authors.initials: M
authors.lastname: May
authors.forename: H-M
authors.initials: HM
authors.lastname: Fritsche
authors.forename: C
authors.initials: C
authors.lastname: Gilfrich
authors.forename: S
authors.initials: S
authors.lastname: Brookman-May
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authors.lastname: Burger
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authors.initials: W
authors.lastname: Otto
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authors.lastname: Bolenz
authors.forename: L
authors.initials: L
authors.lastname: Trojan
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authors.lastname: Herrmann
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authors.initials: MS
authors.lastname: Michel
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authors.lastname: Wülfing
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authors.lastname: Tiemann
authors.forename: S C
authors.initials: SC
authors.lastname: Müller
authors.forename: J
authors.initials: J
authors.lastname: Ellinger
authors.forename: A
authors.initials: A
authors.lastname: Buchner
authors.forename: C G
authors.initials: CG
authors.lastname: Stief
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authors.initials: D
authors.lastname: Tilki
authors.forename: W F
authors.initials: WF
authors.lastname: Wieland
authors.forename: T
authors.initials: T
authors.lastname: Höfner
authors.forename: M
authors.initials: M
authors.lastname: Hohenfellner
authors.forename: A
authors.initials: A
authors.lastname: Haferkamp
authors.forename: J
authors.initials: J
authors.lastname: Roigas
authors.forename: O
authors.initials: O
authors.lastname: Müller
authors.forename: P
authors.initials: P
authors.lastname: Bretschneider-Ehrenberg
authors.forename: M
authors.initials: M
authors.lastname: Zacharias
authors.forename: S
authors.initials: S
authors.lastname: Gunia
authors.forename: P J
authors.initials: PJ
authors.lastname: Bastian
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012737:Sex Factors; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*