Login to Access Video or Poster Abstract: MP21-03
Sources of Funding: None

Introduction

Radical cystectomy (RC) is the gold standard treatment for muscle invasive bladder cancer (MIBC), but is sometimes avoided in the elderly due to concern for increased morbidity. We sought to quantify the perioperative risks of RC among octogenarians and analyze the survival benefit of available treatment modalities in a national database.

Methods

Using the National Cancer Database, we identified patients with non-metastatic MIBC from 2004 to 2013. Patients were stratified by age less than 80 and age 80-89. We assessed trends in management, perioperative mortality, and overall survival. Analysis was performed using chi-square test, multivariate regression, and Cox regression.

Results

A total of 54,201 patients with non-metastatic MIBC were identified, of whom 15,581 (28.8%) were ages 80-89. Compared to younger patients, octogenarians were less likely to undergo RC (18.0% vs. 47.9%, p<0.01) and more likely to be treated with combination chemotherapy and radiation (13.7% vs. 10.1%, p<0.01). On multivariate analysis controlling for Charlson comorbidity index (CCI), race, and facility type, age greater than 80 was independently associated with decreased odds of undergoing RC (OR 0.25, p<0.01). Octogenarians treated with RC have a higher 30-day (5.7% vs. 2.2%, p<0.01) and 90-day mortality (14.5% vs. 6.1%, p<0.01) than younger patients. On multivariate analysis controlling for race, CCI, and facility type, age over 80 is independently associated with 30- and 90-day mortality (OR 2.9 and 2.6, p<0.01). On Cox multivariate analysis controlling for age, race, CCI, stage, tumor size, payer status, grade and facility type, overall survival was highest among octogenarians treated with RC, and sequentially worse for those treated with combination chemoradiation, radiation, and chemotherapy (HR 0.54 vs 0.60 vs 0.75 vs 0.77, respectively; p<0.01; Table 1), compared to TURBT alone.

Conclusions

Despite the survival benefit of RC in MIBC, octogenarians are less likely to undergo RC than younger patients. RC in octogenarians confers a higher 30- and 90-day mortality, but is associated with improved overall survival. Quantifying these risks and benefits improves counseling for octogenarians on optimal management strategies.

Funding

None