Radical Cystectomy and Adjuvant Chemotherapy for Bladder Cancer in the Elderly: A Population-based Study

• Published in: Urology (Ridgewood, N.J.) Vol. 85; no. 4; pp. 791 - 798
• Main Authors: Leveridge, Michael J, Siemens, D. Robert, Mackillop, William J, Peng, Yingwei, Tannock, Ian F, Berman, David M, Booth, Christopher M
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2015
• Subjects: Age Factors; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Blood Vessels - pathology; Carboplatin - therapeutic use; Carcinoma - epidemiology; Carcinoma - secondary; Carcinoma - therapy; Chemotherapy, Adjuvant - trends; Cisplatin - therapeutic use; Cystectomy - trends; Female; Humans; Length of Stay - statistics & numerical data; Lymph Node Excision; Lymphatic Metastasis; Lymphatic Vessels - pathology; Male; Neoadjuvant Therapy - trends; Neoplasm Invasiveness; Neoplasm Staging; Ontario - epidemiology; Patient Readmission - statistics & numerical data; Registries; Socioeconomic Factors; Survival Rate; Urinary Bladder Neoplasms - drug therapy; Urinary Bladder Neoplasms - epidemiology; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urology; Ontario
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2014.12.027

Objective To assess radical cystectomy (RC) outcomes and adjuvant chemotherapy (ACT) use in the elderly in routine practice. Bladder cancer occurs most commonly in the elderly. RC, standard treatment for muscle-invasive bladder cancer, presents challenges in older patients. Suboptimal evidence guides ACT use. Methods All patients undergoing RC for urothelial cancer in Ontario from 1994 to 2008 were identified using the Ontario Cancer Registry. Pathology reports and treatment records were linked to the database. Patients were age stratified as <70, 70-74, 75-79 and ≥80 years. Logistic regression and Cox proportional hazards identified associations with and effectiveness of ACT use. Results We identified 3320 patients: 1362 (41%) aged <70 years; 674 (20%) aged 70-74 years; 674 (19%) aged 75-79 years, and 657 (20%) aged ≥80 years. Thirty-day (1%, 2%, 2%, 6%; P  <.0001) and 90-day (5%, 8%, 9%, 15%; P  <.0001) mortality increased with age. Age-stratified 5-year cancer-specific survival was 42%, 37%, 34%, and 32%, respectively ( P  <.001); 5-year overall survival was 40%, 34%, 28%, and 23%, respectively ( P  <.001). ACT decreased with age (27%, 16%, 12%, 5%; P  <.0001). Among ACT patients, 87% aged <70 years received cisplatin vs 73% aged ≥70 years ( P  = .003). ACT was associated with improved cancer-specific survival (hazard ratio [HR] = 0.73 and 95% confidence interval [CI] = 0.59-0.89 for age <70 years and HR = 0.73 [95% CI = 0.59-0.89] for ≥70 years) and overall survival (HR = 0.70 [95% CI = 0.58-0.85] for age <70 years and HR = 0.70 [95% CI = 0.59-0.84] for ≥70 years) across all age groups. Conclusion Cystectomy carries a higher risk of postoperative mortality in elderly patients in routine clinical practice. ACT is used infrequently in older patients despite a substantial survival benefit observed across all age groups.