Multicenter validation of the prognostic value of patient age in patients treated with radical cystectomy.
OBJECTIVE
Small studies have suggested that older patients have worse outcomes following radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). We evaluated the association of patient age with clinical outcomes in a large multi-institutional RC series.


METHODS
Data were collected from 4,429 patients treated with RC and lymphadenectomy for UCB without neoadjuvant chemotherapy. Age at RC was analyzed both as a continuous and categorical variable.


RESULTS
Higher age at RC, analyzed as a continuous or categorical variable, was associated with advanced pathologic stage (P < 0.001), higher tumor grade (P = 0.045), presence of lymphovascular invasion (P = 0.018), and positive soft-tissue surgical margin status (P = 0.004). Elderly patients were less likely to receive postoperative chemotherapy (P < 0.001). In multivariable analyses, higher age was associated with disease recurrence, cancer-specific, and overall mortality (P < 0.001). Patients ≥ 80 years had a significantly greater risk of cancer-specific mortality than patients <50 years (HR 1.763, P < 0.001). Age minimally improved the accuracy of a base model that included standard pathologic features for prediction of disease recurrence (+0.2-0.3%) and cancer-specific survival (+0.3%). Conversely, age improved the predictive accuracy for overall survival by a sizeable margin (+4.2-4.5%).


CONCLUSIONS
This large external validation study confirms that advanced patient age is minimally but significantly associated with worse prognosis after RC. Nevertheless, a large proportion of elderly patients benefitted from RC with curative intent. We need to improve our understanding of the reasons for the worse UCB outcomes in this growing segment of the population and to develop strategies to improve cancer care in the elderly.
Weill Medical College of Cornell University, 525 East 68th Street, Starr 900, New York, NY 10065, USA.
Thomas F
TF
Chromecki
Julian
J
Mauermann
Eugene K
EK
Cha
Robert S
RS
Svatek
Harun
H
Fajkovic
Pierre I
PI
Karakiewicz
Yair
Y
Lotan
Derya
D
Tilki
Patrick J
PJ
Bastian
Bjoern G
BG
Volkmer
Francesco
F
Montorsi
Wassim
W
Kassouf
Giacomo
G
Novara
Hans-Martin
HM
Fritsche
Vincenzo
V
Ficarra
Christian G
CG
Stief
Colin P
CP
Dinney
Eila
E
Skinner
Karl
K
Pummer
Yves
Y
Fradet
Shahrokh F
SF
Shariat
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D019459:Urothelium / Q000473:pathology