title: Age ≥ 80 years is independently associated with survival outcomes after radical cystectomy: results from the Canadian Bladder Cancer Network Database.
abstract: OBJECTIVE
  The role of advanced age as an independent prognostic factor for clinical outcomes after radical cystectomy is controversial. The objective of the current study was to assess the associations between age and clinical outcomes in a large, multi-institutional series of patients treated with radical cystectomy for bladder cancer.
  
  
  METHODS
  Institutional radical cystectomy databases containing detailed information on bladder cancer patients treated between 1993 and 2008 were obtained from 8 academic centers in Canada. Data were collected on 2,287 patients and combined into a relational database formatted with patient characteristics, pathologic characteristics, recurrence status, and survival status. Patient age was coded as <60 years, 60-69 years, 70-79 years, or ≥ 80 years. Clinical outcomes were 30-day mortality, 90-day mortality, overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS). Logistic regression and Cox proportional hazards regression analysis were used to analyze survival data.
  
  
  RESULTS
  Five hundred fifty-seven (24.6%), 679 (30.0%), 846 (37.4%), and 181 (8.0%) patients were <60 years, 60-69 years, 70-79 years, and ≥ 80 years, respectively. Increased age was associated with decreased utilization rates of neoadjuvant chemotherapy (P = 0.0143), adjuvant chemotherapy (P < 0.0001), and continent urinary diversion (P < 0.0001) as well as advanced pathologic tumor stage (P = 0.0003), increased positive surgical margins (P < 0.0001), and lymphovascular invasion (P = 0.0335). Compared with patients < 60 years, multivariate regression analysis showed that age ≥ 80 years was independently associated with 90-day mortality (OR 2.98, 95% CI 1.22-7.30), OS (HR 2.03, 95% CI 1.51-2.75), DSS (HR 1.56, 95% CI 1.09-2.24), and RFS (HR 2.06, 95% CI 1.57-2.70).
  
  
  CONCLUSIONS
  Age ≥ 80 years at the time of radical cystectomy was independently associated with adverse survival outcomes. These data suggest that increased chronologic age should be considered in clinical trial design and in nomograms predicting survival.
authors: University of Alberta, Edmonton, Alberta, Canada. afairey@ualberta.ca
authors: Adrian S
authors: AS
authors: Fairey
authors: Wassim
authors: W
authors: Kassouf
authors: Armen G
authors: AG
authors: Aprikian
authors: Joe L
authors: JL
authors: Chin
authors: Jonathon I
authors: JI
authors: Izawa
authors: Yves
authors: Y
authors: Fradet
authors: Louis
authors: L
authors: Lacombe
authors: Ricardo A
authors: RA
authors: Rendon
authors: David
authors: D
authors: Bell
authors: Ilias
authors: I
authors: Cagiannos
authors: Darrel E
authors: DE
authors: Drachenberg
authors: Jean-Baptiste
authors: JB
authors: Lattouf
authors: Eric P
authors: EP
authors: Estey
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000601:surgery; D015653:Cystectomy; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000601:surgery