Bladder preservation in octogenarians with invasive bladder cancer

Area of Science:

• Oncology
• Geriatric Medicine
• Urology

Background:

• Transitional cell cancer (TCC) of the bladder is a significant health concern in the elderly.
• Management of invasive TCC in octogenarians often avoids radical cystectomy due to associated risks.
• Understanding outcomes in this specific geriatric population is crucial for treatment planning.

Purpose of the Study:

• To analyze the mortality and morbidity of octogenarians diagnosed with invasive TCC of the bladder.
• To evaluate outcomes in elderly patients managed non-surgically (without cystectomy).
• To identify factors influencing survival and bladder function in this cohort.

Main Methods:

• Retrospective chart review of patients aged 80 years or older with newly diagnosed invasive TCC (pT1 or greater) between 1997 and 2007.
• Analysis of treatment regimens, including transurethral resection, bacillus Calmette-Guerin (BCG), and external beam radiation therapy.
• Correlation of overall survival (OS) and cancer-specific survival (CSS) with tumor stage, mobility, American Society of Anesthesiologists (ASA) score, and age.

Main Results:

• A cohort of 71 octogenarians (mean age 86 years) was analyzed, with 29 having pT1 and 42 having >pT2 tumors.
• Treatment was individualized; 61% of pT1 patients received BCG, and 62% of >pT2 patients received radiation.
• Mean OS was 34 months for pT1 and 14 months for >pT2 tumors (P=.001). Mean CSS was 58 months for pT1 and 11 months for >pT2 tumors (P<.001).
• OS correlated with tumor stage and mobility, less so with ASA score, and minimally with chronological age.
• Bladder function was preserved in 73% of patients. Hospitalization rates were 16% for pT1 vs. 23% for >pT2 patients.

Conclusions:

• Overall survival in elderly bladder cancer patients is influenced by tumor stage, mobility, and comorbidities, necessitating risk-stratified management.
• Patients with pT1G3 tumors and low ASA scores achieve satisfactory survival with bladder preservation.
• Prognosis is poor for patients with > or =pT2 tumors and high ASA scores (3-4); radical cystectomy benefits in younger, healthier patients with > or =pT2 tumors remain uncertain.