Pisano et al. added to this literature by evaluating a large multicenter retrospective cohort of patients undergoing RC for MIBC. 24 centers participated in this study, and patients were analyzed in three groups: 75-79yo, 80-84yo, and 85yo+. 2,006 patients were identified in this age range, and clinical characteristics were listed demonstrating changes in performance status and frailty measures that might be expected as patients age.
Interestingly, they found that patients 85yo+ were more likely to have preoperative hydronephrosis, hematuria, and extravesical disease (indicating that they may have been more likely to receive the operation for symptomatic reasons). They were also more likely to undergo ureterocutaneostomy. Although mortality was greatest in this group, cancer-specific survival did not differ between the age groups, nor did treatment-related mortality.
There were clearly a large number of selection-related factors that help explain these outcomes. The higher use of cutaneous ureterostomies in the oldest group likely prevented many bowel-related and diversion-related complications that often plague RC patients. Furthermore, although patient characteristics were adjusted for, elderly patients who are more fit are more likely to undergo surgery, a selection-bias that is not easy to eliminate in this type of retrospective work.
Despite these minor limitations, this large multi-institutional cohort should make it abundantly clear that age alone should not be a limiting factor to performing a cystectomy in elderly patients with MIBC. Even those 85yo+ will likely benefit, and patients should be counseled as such.
Presented by: Pisano F, University of Turin, Dept. of Urology, Turin, Italy
Written by: Shreyas Joshi, MD, Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark.