Department of Urology and Andrology, Donauspital Langobardenstrasse, Vienna, Austria.
Urology. 2010 Feb;75(2):370-5. doi: 10.1016/j.urology.2009.10.027.
To analyze mortality and morbidity of octogenarians with newly diagnosed invasive transitional cell cancer (TCC) of the bladder who were managed without cystectomy.
Retrospective chart review of all patients with newly diagnosed invasive TCC (> or = pT1) in the period of 1997-2007, who were 80 years or older at diagnosis.
A total of 71 patients (86 + 4 years, mean + standard deviation [SD], pT1: n = 29; > pT2: n = 42) entered this analysis. In this geriatric population, treatment regimens were highly individualized. After transurethral resection, 61% of pT1-patients received bacillus Calmette-Guerin and 62% of those with > pT2-tumors external beam radiation. Mean overall survival (OS) of the entire cohort (n = 71) was 22 + 26 months for pT1-patients 34 + 33 versus 14 + 15 months for those with > or = pT2-tumors (P = .001). Mean cancer-specific survival was 58 months for pT1-patients and 11 months for > or = pT2-patients (P <.001). OS was correlated to tumor stage and the degree of mobility, to a lesser extent to the American Society of Anesthesiologists (ASA) score, and only marginally to chronologic age. Satisfactorily bladder function was preserved in 73%. pT1-patients spent 16% of their remaining life-span in the hospital compared with 23% for patients with > pT2-tumors.
OS in TCC is dependent on tumor stage, age, mobility, and comorbidities, and a risk-stratified management is necessary. Patients with pT1G3 tumor and low ASA score have satisfying OS with bladder preservation, but in patients with > or = pT2 and ASA 3-4 the prognosis is very bad. It remains questionable whether patients with tumor stages > or = pT2 and ASA 1-2 despite high age would benefit from radical cystectomy.
分析未接受膀胱切除术的新诊断为浸润性移行细胞癌（TCC）的 80 岁以上高龄患者的死亡率和发病率。
回顾性分析 1997 年至 2007 年间诊断为浸润性 TCC（>或=pT1）且 80 岁及以上的所有患者的病历。
共有 71 名患者（86+4 岁，平均+标准差[SD]，pT1：n=29；>pT2：n=42）进入本分析。在这个老年人群中，治疗方案高度个体化。在经尿道切除术（TUR）后，61%的 pT1 患者接受卡介苗（BCG）治疗，62%的>pT2 肿瘤患者接受外照射治疗。整个队列（n=71）的总生存（OS），pT1 患者为 22+26 个月，34+33 个月；>pT2 肿瘤患者为 14+15 个月，P=0.001。pT1 患者的癌症特异性生存（CSS）为 58 个月，>pT2 患者为 11 个月，P<0.001。OS 与肿瘤分期和活动能力相关，与美国麻醉医师协会（ASA）评分相关程度较低，与年龄相关程度较低。73%的患者保留了满意的膀胱功能。pT1 患者在剩余生命中住院的时间占 16%，而>pT2 肿瘤患者占 23%。
TCC 的 OS 取决于肿瘤分期、年龄、活动能力和合并症，需要进行风险分层管理。具有 pT1G3 肿瘤和低 ASA 评分的患者具有满意的膀胱保留 OS，但>或=pT2 且 ASA 3-4 的患者预后非常差。对于肿瘤分期>或=pT2 且 ASA 1-2 的高龄患者，是否会从根治性膀胱切除术获益仍存在疑问。
