title: Radical cystectomy and adjuvant chemotherapy for bladder cancer in the elderly: a population-based study.
abstract: OBJECTIVE
  To assess radical cystectomy (RC) outcomes and adjuvant chemotherapy (ACT) use in the elderly in routine practice. Bladder cancer occurs most commonly in the elderly. RC, standard treatment for muscle-invasive bladder cancer, presents challenges in older patients. Suboptimal evidence guides ACT use.
  
  
  METHODS
  All patients undergoing RC for urothelial cancer in Ontario from 1994 to 2008 were identified using the Ontario Cancer Registry. Pathology reports and treatment records were linked to the database. Patients were age stratified as <70, 70-74, 75-79 and ≥80 years. Logistic regression and Cox proportional hazards identified associations with and effectiveness of ACT use.
  
  
  RESULTS
  We identified 3320 patients: 1362 (41%) aged <70 years; 674 (20%) aged 70-74 years; 674 (19%) aged 75-79 years, and 657 (20%) aged ≥80 years. Thirty-day (1%, 2%, 2%, 6%; P <.0001) and 90-day (5%, 8%, 9%, 15%; P <.0001) mortality increased with age. Age-stratified 5-year cancer-specific survival was 42%, 37%, 34%, and 32%, respectively (P <.001); 5-year overall survival was 40%, 34%, 28%, and 23%, respectively (P <.001). ACT decreased with age (27%, 16%, 12%, 5%; P <.0001). Among ACT patients, 87% aged <70 years received cisplatin vs 73% aged ≥70 years (P = .003). ACT was associated with improved cancer-specific survival (hazard ratio [HR] = 0.73 and 95% confidence interval [CI] = 0.59-0.89 for age <70 years and HR = 0.73 [95% CI = 0.59-0.89] for ≥70 years) and overall survival (HR = 0.70 [95% CI = 0.58-0.85] for age <70 years and HR = 0.70 [95% CI = 0.59-0.84] for ≥70 years) across all age groups.
  
  
  CONCLUSIONS
  Cystectomy carries a higher risk of postoperative mortality in elderly patients in routine clinical practice. ACT is used infrequently in older patients despite a substantial survival benefit observed across all age groups.
authors: Department of Urology, Queen's University, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada. Electronic address: leveridm@kgh.kari.net.
authors: Michael J
authors: MJ
authors: Leveridge
authors: Department of Urology, Queen's University, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada.
authors: D Robert
authors: DR
authors: Siemens
authors: Department of Oncology, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.
authors: William J
authors: WJ
authors: Mackillop
authors: Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.
authors: Yingwei
authors: Y
authors: Peng
authors: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Ian F
authors: IF
authors: Tannock
authors: Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada.
authors: David M
authors: DM
authors: Berman
authors: Department of Oncology, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.
authors: Christopher M
authors: CM
authors: Booth
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001808:Blood Vessels / Q000473:pathology; D016190:Carboplatin / Q000627:therapeutic use; D002277:Carcinoma / Q000453:epidemiology / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000639:trends; D002945:Cisplatin / Q000627:therapeutic use; D015653:Cystectomy / Q000639:trends*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D020360:Neoadjuvant Therapy / Q000639:trends; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009864:Ontario / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D012042:Registries; D012959:Socioeconomic Factors; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D002945:Cisplatin