Increased Use of Cystectomy in Patients 75 and Older: a Contemporary Analysis of Survival and Perioperative Outcomes From the National Cancer Data Base

To assess national utilization patterns for cystectomy and non-surgical treatments for elderly patients with muscle-invasive bladder cancer (MIBC).

From the National Cancer Data Base (NCDB), we identified patients ≥75 years old with T2-T4, non-metastatic urothelial carcinoma between 2003 and 2012. Patients were grouped by treatment: cystectomy, chemoradiation, or non-standard treatment. Cochran-Armitage trend test was used to evaluate time trends for treatments and perioperative outcomes. Kaplan-Meier and Cox regression tests were used for overall survival (OS) analyses.

Of 18,945 patients with MIBC, 3898 (21%) underwent cystectomy. Cystectomy use increased from 14% in 2003 to 24% in 2012 (p<0.01 for overall trend). Inpatient length of stay after cystectomy decreased over time (p= 0.02), while 30-day readmission and mortality rates remained stable (p=0.86 and p=0.73, respectively). Median OS (95% CI) was 26.5 (23.1-28.9) months for cystectomy, 22.1 (20.1-24.2) months for chemoradiation, and 12.0 (11.3-12.7) months for non-standard treatment (p<0.01). The survival benefit of cystectomy compared to non-standard treatment was seen regardless of comorbidity burden. In the Cox analysis, the hazard of death was 0.69 (95% CI 0.63-0.75, p<0.01) for cystectomy and 0.75 (95% CI 0.70-0.82, p<0.01) for chemoradiation compared to non-standard treatment.

Cystectomy use is increasing in elderly patients, with stable or improved perioperative outcomes and improved survival compared to non-standard treatment. These findings support continued use of cystectomy in appropriately selected elderly patients.

Urology. 2016 Oct 17 [Epub ahead of print]

Matthew J Bream, Matthew J Maurice, Joshua Altschuler, Hui Zhu, Robert Abouassaly

University Hospitals Case Medical Center, Case Western Reserve University, Urology Institute, Cleveland, Ohio., Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio., Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio., University Hospitals Case Medical Center, Case Western Reserve University, Urology Institute, Cleveland, Ohio. Electronic address: .