title: Diminished efficacy of Bacille Calmette-Guérin among elderly patients with nonmuscle invasive bladder cancer.
abstract: OBJECTIVE
  Bacille Calmette-Guérin (BCG) is recommended as adjunctive therapy among patients with high-risk nonmuscle-invasive bladder cancer (BC). Given that immune response is attenuated with age, we set out to determine the impact of age on response to BCG.
  
  
  METHODS
  We searched our prospective bladder information system and limited our search to patients with incident BC completely resected at transurethral resection (TUR) who completed a full induction course of BCG. We then analyzed the impact of age on outcome. Age was analyzed both dichotomously (greater or less than 75 years) as well as by 10-year increments. The main outcomes were recurrence or progression-free survival. Log-rank and multivariable Cox proportional-hazard analyses, adjusting for clinical and pathologic features (age, multifocality, pathologic stage, grade and associated carcinoma in situ, maintenance, and restaging) were used.
  
  
  RESULTS
  This cohort included 238 patients. Baseline parameters were similar aside from tumor number. Progression-free survival differed between age groups when examined either dichotomously or via 10-year increments. The 2-year progression-free survival was 87% among patients <75 years vs 65% in patients >75 years (log rank P <.001). An age-dependent trend was noted when analyzed by 10-year increment (log-rank for trend P = .011). On multivariable analysis, age was an independent risk factor for progression (HR = 2.9, 95% CI 1.7-4.9). Recurrence-free survival was similar among age strata.
  
  
  CONCLUSIONS
  We demonstrated that advanced age is associated with higher progression rates despite BCG. The care of BC in the elderly population is of increasing concern and should be addressed in a prospective clinical study.
authors.affiliation: Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada. sdmargel@gmail.com
authors.forename: David
authors.initials: D
authors.lastname: Margel
authors.forename: Sultan S
authors.initials: SS
authors.lastname: Alkhateeb
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
authors.forename: Neil
authors.initials: N
authors.lastname: Fleshner
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001500:BCG Vaccine / Q000627:therapeutic use*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007107:Immune System; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D001500:BCG Vaccine