Introduction

Radical cystectomy (RC) remains underutilized in patients with non-muscle invasive bladder cancer (NMIBC), particularly elderly patients, despite data demonstrating inferior survival for patients with NMIBC who experience disease progression. We evaluated the association of age with perioperative and oncologic outcomes after RC for NMIBC.

Methods

Multi-institutional review of patients with NMIBC managed with RC between 2000-2013. Patients were stratified by age: <70 versus ≥70. Associations of age with receipt of perioperative blood transfusion (PBT), prolonged operative time (≥75th%; pORT) and length of stay (≥75th%; pLOS), pathology at RC, and 30/90 day complications were assessed using multivariable logistic regression. Recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS) were evaluated using the Kaplan-Meier method, multivariable Cox proportional hazards regression models, and competing risks models.

Results

A total of 489 patients were identified, of whom 263 (55.8%) were <70 and 226 (46.2%) were ≥70. On multivariable analysis, age ≥70 was not significantly associated with patients’ risk of receipt of a PBT, pORT, pathologic stage pT2-4 or pN+, 30 day or 90 day grade III+ complications (all p>0.05). pLOS was more likely in older patients (OR 1.77; 95%CI 1.09-2.85; p=0.02). Estimated 5-yr RFS, CSS, and OS in patients <70 versus ≥70 was 70% vs 62% (p=0.14), 84% vs 77% (p=0.06), and 74% vs 54% (p<0.01). On multivariable Cox regression analyses, age ≥70 was not independently associated with RFS (HR 1.10; 95% CI 0.79-1.52; p=0.57) or CSS (HR 1.22; 95% CI 0.82-1.82; p=0.32), but remained associated with decreased OS (HR 1.91; 95% CI 1.50-2.45; p<0.01). Moreover, among all patients and as stratified by age, pathologic upstaging was associated with worse RFS, CSS, and OS on both multivariable Cox proportional hazards regression and in competing risk (of non-cancer death) models (Table).

Conclusions

Older patients with NMIBC had similar risks of pathologic upstaging at RC, and patients upstaged at surgery had inferior cancer outcomes across age strata. Meanwhile, advanced age was not associated with increased risks of PBT, pORT, or perioperative complications. These data support the use of RC for select older patients with high-risk NMIBC.

Funding

None