Bladder cancer in patients younger than 40 years: outcomes from the National Cancer Database.

To evaluate the clinical, pathological, and survival outcomes of bladder cancer in patients aged 18-40 years.

We identified 362,091 bladder cancer patients from the National Cancer Database between 2004-2013 and compared patients aged 18-40 years to those > 40 years of age with univariate analysis using Chi-square tests.

A subset analysis was performed on patients who underwent cystectomy. Multivariable Cox regression was used for overall survival analysis.

Our final analysis included 314,177 patients with 3314 (1.1%) patients aged 18-40 years. Patients aged 18-40 years had a lower male-to-female ratio (2.4 versus 3.0), a greater proportion of low-grade tumors (72.7% versus 48.3%, p < 0.001), non-muscle invasive tumors (90.3% versus 81.2%, p < 0.001), and variant histology (4.0% versus 3.3%, p < 0.001). Similar trends were observed at cystectomy including lower male-to-female ratio in the 18-40 years group (1.7 versus 3.1), a greater proportion of variant histology (25.0% versus 10.0%, p < 0.001); and 53.3% of those younger patients with variant histology were women. Patients aged 18-40 years who underwent cystectomy had a higher proportion of locally advanced disease (pT4 19.2% versus 14.6%, p = 0.004). Multivariable analyses in both cohorts demonstrated that variant histology was a predictor of worse overall survival.

The majority of patients aged 18-40 years with bladder cancer present with low-grade, non-muscle-invasive disease associated with better survival. However, a subset of younger patients with a higher proportion of women presents with aggressive bladder cancer which may be partly explained by a higher prevalence of variant histology.

World journal of urology. 2020 Jul 31 [Epub ahead of print]

Claire M de la Calle, Samuel L Washington, Peter E Lonergan, Maxwell V Meng, Sima P Porten

Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, 1825 4th Street, San Francisco, CA, 94158, USA. ., Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, 1825 4th Street, San Francisco, CA, 94158, USA.

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