Chromecki, Thomas F. and Mauermann, Julian and Cha, Eugene K. and Svatek, Robert S. and Fajkovic, Harun and Karakiewicz, Pierre I. and Lotan, Yair and Tilki, Derya and Bastian, Patrick J. and Volkmer, Bjoern G. and Montorsi, Francesco and Kassouf, Wassim and Novara, Giacomo and Fritsche, Hans-Martin and Ficarra, Vincenzo and Stief, Christian G. and Dinney, Colin P. and Skinner, Eila and Pummer, Karl and Fradet, Yves and Shariat, Shahrokh F. (2012) Multicenter validation of the prognostic value of patient age in patients treated with radical cystectomy. WORLD JOURNAL OF UROLOGY, 30 (6). pp. 753-759. ISSN 0724-4983, 1433-8726
Full text not available from this repository. (Request a copy)Abstract
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. 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. 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 a parts per thousand yen80 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%). 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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | INVASIVE BLADDER-CANCER; OLDER; THERAPY; CARCINOMA; SURVIVAL; OUTCOMES; SERIES; Age; Prognosis; Radical cystectomy; Survival; Urothelial carcinoma |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 04 May 2020 05:48 |
| Last Modified: | 04 May 2020 05:48 |
| URI: | https://pred.uni-regensburg.de/id/eprint/17689 |
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