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Assessing the safety of bladder-preserving therapy as an alternative to surgical intervention in elderly patients with muscle invasive bladder cancer

  • 0Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA.
Urologia +

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July 26, 2024

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July 26, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Radical cystectomy with chemotherapy offers better survival for elderly muscle invasive bladder cancer patients than bladder-sparing treatments. Bladder preservation is best for those unfit for surgery.

Area Of Science

  • Urology
  • Oncology
  • Geriatrics

Background

  • Muscle invasive bladder cancer (MIBC) in elderly patients presents treatment challenges.
  • Bladder-preserving therapies are being explored as alternatives to radical cystectomy (RC).

Purpose Of The Study

  • To evaluate the safety and efficacy of bladder-preserving therapy versus radical cystectomy in octogenarian patients with MIBC.
  • To compare survival outcomes between different treatment modalities for MIBC in the elderly.

Main Methods

  • Retrospective analysis of the Surveillance, Epidemiology and End Results (SEER) database for patients aged 80+ with non-metastasized MIBC.
  • Comparison of survival between radical cystectomy (with or without chemotherapy) and chemotherapy/radiation without cystectomy.
  • Application of log-rank tests, Kaplan-Meier, Cox regression, and propensity score matching for survival analysis.

Main Results

  • A total of 2995 patients were analyzed: 49.98% underwent RC only, 8.65% RC with chemotherapy, and 41.37% chemotherapy/radiation without RC.
  • Median overall survival was 31.4 months (RC only), 44.1 months (RC/chemotherapy), and 24.6 months (chemotherapy/radiation).
  • Multivariate analysis and propensity score matching indicated significantly worse survival for RC only and chemotherapy/radiation groups compared to RC/chemotherapy.

Conclusions

  • Radical cystectomy combined with chemotherapy is recommended as the definitive local therapy for octogenarians with localized bladder cancer.
  • Bladder-sparing treatment alternatives should be reserved for elderly patients who are not candidates for radical cystectomy due to surgical unfitness.

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