Bladder Cancer in Patients Younger than 40 years: Outcomes from the National Cancer Database - Beyond the Abstract
Relatively little is known about bladder cancer in younger patients and how outcomes may differ compared to older patients. Here, using the National Cancer Database, we evaluated a population of 314,177 bladder cancer patients between 2004 and 2013, including 3,314 patients aged 18-40 years. We compared the younger adults aged 18-40 years to those >40 years and found that most adult patients 18 to 40 years have low-grade low-stage urothelial carcinoma, with a good prognosis, which is consistent with previous studies, however, most of these studies were small retrospective cohorts and most excluded variant histologies. Using a considerably larger cohort, we were able to identify two subsets of younger adults with aggressive disease and worse prognoses: younger patients with variant histologies and those with urothelial carcinoma. These findings suggest that those with variant histologies and a subset with urothelial carcinoma may require early aggressive management.
This study is limited by its retrospective nature and the lack of granular information provided by the National Cancer Database. Yet, the population-based data generated by a nationwide database of this caliber gives us a unique insight into the clinical, pathological, and survival outcomes of bladder cancer in a small subset of bladder cancer patients such as those aged 18 to 40 years. More studies will be needed however to determine how to better risk stratify young adults at the time of diagnosis.
Written by: Claire de la Calle, MD, Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA