San Antonio, Texas USA (UroToday.com) Radical cystectomy (RC) is the gold standard therapy for patient with muscle invasive bladder cancer (MIBC) as is the treatment associated with the best oncological outcomes. However, RC comes with great morbidity with overall 90 day complication rate of approximately 30%. Thus, RC has been seldomly performed in elderly patients especially those in the later decades of life.
In this study by Boysen and colleagues, the sought to identify the perioperative risks of RC among octogenarians and analyze the survival benefit of available treatment modalities using the National Cancer Data Base. A total of 15,581 patients with MIBC between the ages of 80-89 were identified in the data base. Compared to younger patients octogenarians were less likely to undergo RC (18.0% vs. 47.9%) and more likely to be treated with multimodal therapy chemotherapy/radiation (13.7% vs. 10.1%).
The authors then performed a multivariate analysis controlling for Charlson comorbidity index (CCI), race, and facility type assessing the risk of 30-day and 90-day mortality following RC. Age > 80 year old was found to be an independent predictor of 30-day and 90-day mortality with an OR of 2.9 and 2.6, respectively. A Cox proportional multivariate analysis was then performed to assess overall survival associated with each treatment modality (RC, TURBT + chemotherapy, TURBT + radiation, TURBT + chemotherapy + radiation) showing that overall survival was highest among octogenarians treated with RC and sequentially worse with those treated with combination chemo/radiation, radiation and chemotherapy (HR 0.54 vs HR 0.60 vs HR 0.75 vs HR 0.77) compared to TURBT alone.
This population based study shows that octogenarians are less likely to receive RC compared to their younger counterparts although is associated with improved overall survival compared to other treatment modalities. RC in octogenarians is associated with a higher 30-day and 90-day mortality compared to their younger counterparts even when the groups are controlled for comorbidity index.
The study must be taken carefully as with any population survey there is inherent selection bias that is challenging to control in the analysis. Also there while RC may provide a higher overall survival it does not translate into a higher quality of life in patients in the elderly population. An interesting question would be is cancer control with multimodal management provide a higher quality of life in patents in whom the estimate survival is usually less than 10 years.
Authors: William Boysen, Vignesh Packiam, Joseph Rodriguez III, Melanie A. Adamsky, Norm Smith and Gary D. Steinberg
University of Chicago
Written By: Andres F. Correa, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center
17th Annual Meeting of the Society of Urologic Oncology - November 30 -December 2, 2016 – San Antonio, Texas USA