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

Thomas F. Chromecki, Julian Mauermann, Eugene K. Cha, Robert S. Svatek, Harun Fajkovic, Pierre I. Karakiewicz, Yair Lotan, Derya Tilki, Patrick J. Bastian, Bjoern G. Volkmer, Francesco Montorsi, Wassim Kassouf, Giacomo Novara, Hans Martin Fritsche, Vincenzo Ficarra, Christian G. Stief, Colin P. Dinney, Eila Skinner, Karl Pummer, Yves FradetShahrokh F. Shariat

Research output: Contribution to journalArticle

17 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)753-759
Number of pages7
JournalWorld Journal of Urology
Volume30
Issue number6
DOIs
StatePublished - Dec 1 2012

    Fingerprint

Keywords

  • Age
  • Prognosis
  • Radical cystectomy
  • Survival
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Chromecki, T. F., Mauermann, J., Cha, E. K., Svatek, R. S., Fajkovic, H., Karakiewicz, P. I., Lotan, Y., Tilki, D., Bastian, P. J., Volkmer, B. G., Montorsi, F., Kassouf, W., Novara, G., Fritsche, H. M., Ficarra, V., Stief, C. G., Dinney, C. P., Skinner, E., Pummer, K., ... Shariat, S. F. (2012). Multicenter validation of the prognostic value of patient age in patients treated with radical cystectomy. World Journal of Urology, 30(6), 753-759. https://doi.org/10.1007/s00345-011-0772-2