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Multicenter validation of the prognostic value of patient age in patients treated with radical cystectomy

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Abstract

Purpose

Small studies have suggested that older patients have worse outcomes following radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). We evaluated the association of patient age with clinical outcomes in a large multi-institutional RC series.

Methods

Data were collected from 4,429 patients treated with RC and lymphadenectomy for UCB without neoadjuvant chemotherapy. Age at RC was analyzed both as a continuous and categorical variable.

Results

Higher age at RC, analyzed as a continuous or categorical variable, was associated with advanced pathologic stage (P < 0.001), higher tumor grade (P = 0.045), presence of lymphovascular invasion (P = 0.018), and positive soft-tissue surgical margin status (P = 0.004). Elderly patients were less likely to receive postoperative chemotherapy (P < 0.001). In multivariable analyses, higher age was associated with disease recurrence, cancer-specific, and overall mortality (P < 0.001). Patients ≥80 years had a significantly greater risk of cancer-specific mortality than patients <50 years (HR 1.763, P < 0.001). Age minimally improved the accuracy of a base model that included standard pathologic features for prediction of disease recurrence (+0.2–0.3%) and cancer-specific survival (+0.3%). Conversely, age improved the predictive accuracy for overall survival by a sizeable margin (+4.2–4.5%).

Conclusions

This large external validation study confirms that advanced patient age is minimally but significantly associated with worse prognosis after RC. Nevertheless, a large proportion of elderly patients benefitted from RC with curative intent. We need to improve our understanding of the reasons for the worse UCB outcomes in this growing segment of the population and to develop strategies to improve cancer care in the elderly.

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Abbreviations

UCB:

Urothelial carcinoma of the bladder

RC:

Radical cystectomy

LN:

Lymph nodes

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Conflict of interest

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Author information

Authors and Affiliations

  1. Weill Medical College of Cornell University, 525 East 68th Street, Starr 900, New York, NY, 10065, USA

    Thomas F. Chromecki, Eugene K. Cha, Harun Fajkovic & Shahrokh F. Shariat

  2. Medical University of Graz, Graz, Austria

    Thomas F. Chromecki & Karl Pummer

  3. Laval University, Quebec City, QC, Canada

    Julian Mauermann & Yves Fradet

  4. UT Health Science Center San Antonio, San Antonio, TX, USA

    Robert S. Svatek

  5. Landeskrankenhaus St. Poelten, St. Poelten, Austria

    Harun Fajkovic

  6. University of Montréal, Montréal, QC, Canada

    Pierre I. Karakiewicz

  7. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Yair Lotan

  8. Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany

    Derya Tilki, Patrick J. Bastian & Christian G. Stief

  9. University of Ulm, Ulm, Germany

    Bjoern G. Volkmer

  10. Vita Salute San Raffaele University, Milan, Italy

    Francesco Montorsi

  11. McGill University Health Centre, Montréal, QC, Canada

    Wassim Kassouf

  12. University of Padua, Padua, Italy

    Giacomo Novara & Vincenzo Ficarra

  13. University of Regensburg, Regensburg, Germany

    Hans-Martin Fritsche

  14. University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Colin P. Dinney

  15. University of Southern California, Los Angeles, CA, USA

    Eila Skinner

Authors
  1. Thomas F. Chromecki
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  2. Julian Mauermann
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  3. Eugene K. Cha
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  6. Pierre I. Karakiewicz
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  7. Yair Lotan
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  8. Derya Tilki
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  9. Patrick J. Bastian
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  11. Francesco Montorsi
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  13. Giacomo Novara
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  15. Vincenzo Ficarra
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  16. Christian G. Stief
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  17. Colin P. Dinney
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  18. Eila Skinner
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  19. Karl Pummer
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  20. Yves Fradet
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  21. Shahrokh F. Shariat
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Corresponding author

Correspondence to Shahrokh F. Shariat.

Additional information

T. F. Chromecki and J. Mauermann are contributed equally.

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Chromecki, T.F., Mauermann, J., Cha, E.K. et al. Multicenter validation of the prognostic value of patient age in patients treated with radical cystectomy. World J Urol 30, 753–759 (2012). https://doi.org/10.1007/s00345-011-0772-2

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  • DOI: https://doi.org/10.1007/s00345-011-0772-2

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