Elderly patients with muscle invasive bladder cancer can pose a therapeutic dilemma given multiple comorbidities which may preclude surgery. This registry-based analysis investigated treatment patterns and survival outcomes in this group of patients.
We queried the National Cancer Database for muscle-invasive (cT2-T4aN0M0) bladder cancer in patients 80 years or older diagnosed from 2004-2013. Included patients underwent TURBT followed by radical cystectomy (RC), RC plus chemotherapy (RC+C), radiation therapy alone (RT), chemotherapy alone (CT), chemoradiation (CRT), or no treatment. Kaplan-Meier, log-rank, and multivariate Cox proportional hazards regression, and propensity score matching was performed.
9,270 patients were identified with a median follow-up of 12.8 months. Median overall survival (OS) for patients treated with RC alone was 23.2 months (95% CI, 19.8-26.6) and superior to CT or RT alone (P<0.0001). CRT had median OS of 27.3 months (95% CI, 25.0-29.7) which was not statistically different from RC alone (P=0.39). RC+C had the longest median OS of 34.5 months (95% CI, 22.2-46.7) (P<0.0001 compared to both CRT and RC alone). On multivariate analysis and propensity score matching, the best OS was seen in patients treated with RC+C and there was no difference in OS between CRT and RC alone.
For elderly patients with muscle invasive bladder cancer, chemoradiation is an alternative definitive treatment strategy with survival equal to RC alone and superior to either CT or RT alone. If one is able to receive neoadjuvant or adjuvant chemotherapy with surgery, additional survival is observed in this non-randomized study.
The Journal of urology. 2017 Aug 22 [Epub ahead of print]
Benjamin W Fischer-Valuck, Yuan James Rao, Soumon Rudra, Daniel Przybysz, Elizabeth Germino, Pamela Samson, Brian C Baumann, Hiram Gay, Jeff Michalski
*Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO., *Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO. Electronic address: .