Department of Urology, the Genitourinary Oncology Service in the Department of Medicine (MIM), and the Department of Epidemiology and Biostatistics (AC), Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
J Urol. 2010 Jun;183(6):2171-7. doi: 10.1016/j.juro.2010.02.015.
Surveillance, Epidemiology, and End Results data indicate only 19.7% of patients 80 years old or older with muscle invasive bladder cancer undergo radical cystectomy vs 49.4% of those with similar stage disease age 65 to 79 years, reflecting concern for perioperative morbidity. We evaluated the morbidity and survival outcomes of octogenarians treated with radical cystectomy at a tertiary cancer center.
We conducted a retrospective review of 1,142 patients entered prospectively into a hospital based complication database between 1995 and 2005 using a modified Clavien system. Complications were classified as minor or major based on the complexity of intervention required. Disease specific and competing risk survival curves for patients younger than 80 years vs 80 years old or older were created.
Octogenarians had a nonsignificantly higher rate of minor (55% vs 50%) and major complications (17% vs 13%) than younger patients, respectively (global p = 0.15). After adjusting for baseline characteristics the risk of any complication was roughly flat across all ages (p = 0.9). For major complications risk appeared to increase slightly up to age 65 years and then plateau (p = 0.16). After adjusting for deaths from other causes the cumulative incidence of death from bladder cancer in octogenarians was comparable to that in younger patients (5-year cumulative incidence of death from bladder cancer 26% vs 25%).
In our experience radical cystectomy in older patients with bladder cancer provides similar disease control and survival outcomes with risks of high grade perioperative morbidity comparable to those in younger patients, and remains an important treatment option.
监测、流行病学和最终结果数据表明，80 岁或以上患有肌层浸润性膀胱癌的患者中，仅有 19.7%接受根治性膀胱切除术，而年龄在 65 至 79 岁之间、具有相似分期疾病的患者中，这一比例为 49.4%，这反映出对围手术期发病率的担忧。我们评估了在三级癌症中心接受根治性膀胱切除术治疗的 80 岁以上患者的发病率和生存结局。
我们对 1995 年至 2005 年期间在医院并发症数据库中前瞻性入组的 1142 名患者进行了回顾性分析，采用改良的 Clavien 系统进行分析。并发症根据所需干预的复杂性分为轻微或严重。为年龄小于 80 岁的患者和 80 岁或以上的患者创建了疾病特异性和竞争风险生存曲线。
80 岁以上患者的轻微并发症（55%比 50%）和严重并发症（17%比 13%）发生率均略高，但差异无统计学意义（总体 p = 0.15）。调整基线特征后，各年龄段的任何并发症风险大致持平（p = 0.9）。对于严重并发症，风险似乎在 65 岁之前略有增加，然后趋于平稳（p = 0.16）。在调整因其他原因导致的死亡后，80 岁以上患者膀胱癌死亡的累积发生率与年轻患者相当（膀胱癌 5 年累积死亡率 26%比 25%）。
根据我们的经验，在 80 岁以上膀胱癌患者中进行根治性膀胱切除术可获得相似的疾病控制和生存结局，且严重围手术期发病率风险与年轻患者相当，仍是一种重要的治疗选择。
