title: Does urothelial cancer of bladder behave differently in young patients?
abstract: BACKGROUND
  Bladder urothelial cancer has been diagnosed at an increasing rate among young adults in China while the clinical outcomes remain highly controversial. To optimize the management of young patients with bladder cancer, we examined whether bladder urothelial cancer in young patients behaved differently from that in the elder patients.
  
  
  METHODS
  From 1994 to 2008, a database of bladder urothelial cancer patients at a major tertiary medical center was retrospectively reviewed. The clinical and pathological parameters of patients who were less than 40 years of age and a series of patients older than 40 years of age as the control group during the same period were compared. A survival analysis was performed using the Kaplan-Meier method and log-rank test, and Cox regression was performed to identify clinical parameters that affected the clinic outcomes.
  
  
  RESULTS
  Young bladder cancer patients had a lower male-to-female ratio and were less likely to have advanced stages and high-grade cancers at the initial diagnosis. Tumors in young bladder cancer patients tended to be less multifocal at diagnosis. In addition, young patients had a lower recurrence rate and longer recurrence interval than older patients. The Kaplan-Meier curve and Log-rank test showed that young patients had significantly better cancer specific survival than old patients. The univariate and multivariate Cox regression analysis revealed that tumor grade is the sole predictor for tumor recurrence in young patients.
  
  
  CONCLUSIONS
  Young patients with bladder cancer have favorable pathological features and clinical outcomes than older patients. These findings argue for more conservative management approaches for young patients with bladder cancer.
authors.affiliation: Department of Urology, Tongji Hospital affiliated Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
authors.forename: Zhi-Hua
authors.initials: ZH
authors.lastname: Wang
authors.forename: You-Yuan
authors.initials: YY
authors.lastname: Li
authors.forename: Zhi-Quan
authors.initials: ZQ
authors.lastname: Hu
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
authors.forename: Qian-Yuan
authors.initials: QY
authors.lastname: Zhuang
authors.forename: Yong
authors.initials: Y
authors.lastname: Qi
authors.forename: Zhang-Qun
authors.initials: ZQ
authors.lastname: Ye
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012737:Sex Factors; D001749:Urinary Bladder Neoplasms / Q000473:pathology*; D019459:Urothelium / Q000473:pathology*; D055815:Young Adult