Comparison of standard vs. palliative management for bladder cancer in patients older than 85 years: multicenter study of 317 de novo tumors.

The peak incidence of bladder cancer (BCa) occurs at 85 years but data on treatment and outcome are sparse in this age group. We aimed to compare the outcomes of high-grade nonmuscle invasive BCa (HG NMIBC) and muscle invasive BCa (MIBC) treated with standard therapies vs. palliative management in patients >85 years.

Retrospective multicenter study of 317 patients >85 years who underwent transurethral resection (TURB) for de novo BCa between 2014 and 2016. Standard management consisted in following EAU-guidelines and palliative in monitoring patients without applying oncological treatments after TURB. Low-grade tumors were not compared because all of them were considered to have followed a standard management.

Median age was 87 years (85-97). ASA-score was as follows: II, 34.7%; III, 52.1%; IV, 13.2%. Pathological examination showed: 86 Low-grade NMIBC (27.1%), 156 HG NMIBC (49.2%), and 75 MIBC (23.7%). Median follow-up of the series was 21 months (3-61) and median overall survival (OS) 29 (24-33). Among HG NMIBC, 77 patients (49.4%) received standard treatments (BCG, restaging TURB) and 79 (50.6%) palliative management. Among MIBC, 24 (32%) received standard management (cystectomy, radiotherapy, chemotherapy) and 51 (68%) palliative. Applying standard management in HG NMIBC was an independent prognostic factor of OS (44 months vs. 24, HR 1.95; P = 0.013) and decreased the emergency visit rate (33% vs. 43%). In MIBC, the type of management was not a related to OS (P = 0.439) and did not decrease the emergency visit rate (33% vs. 33%). ASA and Charlson-score were not predictors of OS in HG NMIBC (P = 0.368, P = 0.386) and MIBC (P = 0.511, P = 0.665).

Chronological age should not be a contraindication for applying standard therapies in NMIBC. In MIBC the survival is low regardless of the type of management. The lack of correlation between OS and ASA or Charlson-score raises the necessity of a geriatric assessment for selecting the best treatment strategy.

Urologic oncology. 2019 Oct 02 [Epub ahead of print]

Albert Carrion, Jorge Huguet, Maria José Ribal, Arturo Domínguez, Xavier Bonet, Pol Servián, Olga Mayordomo, Tarek Ajami, Natalia Piccola, Roger Freixa, Fernando Díaz, Fernando Lozano, Carles Raventós, Juan Morote

Department of Urology, Hospital of Vall Hebron, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: ., Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain., Department of Urology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain., Department of Urology, Hospital Parc Taulí, Autonomous University of Barcelona, Barcelona, Spain., Department of Urology, Hospital Bellvitge, University of Barcelona, Barcelona, Spain., Department of Urology, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Barcelona, Spain., Department of Urology, Hospital of Vall Hebron, Autonomous University of Barcelona, Barcelona, Spain.