University of Alberta, Edmonton, Alberta, Canada.
Urol Oncol. 2012 Nov-Dec;30(6):825-32. doi: 10.1016/j.urolonc.2011.07.014. Epub 2011 Sep 1.
The role of advanced age as an independent prognostic factor for clinical outcomes after radical cystectomy is controversial. The objective of the current study was to assess the associations between age and clinical outcomes in a large, multi-institutional series of patients treated with radical cystectomy for bladder cancer.
Institutional radical cystectomy databases containing detailed information on bladder cancer patients treated between 1993 and 2008 were obtained from 8 academic centers in Canada. Data were collected on 2,287 patients and combined into a relational database formatted with patient characteristics, pathologic characteristics, recurrence status, and survival status. Patient age was coded as <60 years, 60-69 years, 70-79 years, or ≥ 80 years. Clinical outcomes were 30-day mortality, 90-day mortality, overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS). Logistic regression and Cox proportional hazards regression analysis were used to analyze survival data.
Five hundred fifty-seven (24.6%), 679 (30.0%), 846 (37.4%), and 181 (8.0%) patients were <60 years, 60-69 years, 70-79 years, and ≥ 80 years, respectively. Increased age was associated with decreased utilization rates of neoadjuvant chemotherapy (P = 0.0143), adjuvant chemotherapy (P < 0.0001), and continent urinary diversion (P < 0.0001) as well as advanced pathologic tumor stage (P = 0.0003), increased positive surgical margins (P < 0.0001), and lymphovascular invasion (P = 0.0335). Compared with patients < 60 years, multivariate regression analysis showed that age ≥ 80 years was independently associated with 90-day mortality (OR 2.98, 95% CI 1.22-7.30), OS (HR 2.03, 95% CI 1.51-2.75), DSS (HR 1.56, 95% CI 1.09-2.24), and RFS (HR 2.06, 95% CI 1.57-2.70).
Age ≥ 80 years at the time of radical cystectomy was independently associated with adverse survival outcomes. These data suggest that increased chronologic age should be considered in clinical trial design and in nomograms predicting survival.
年龄较大作为根治性膀胱切除术临床结局的独立预后因素仍存在争议。本研究的目的是在一个大型的多机构膀胱癌根治性膀胱切除术患者系列中，评估年龄与临床结局之间的关系。
从加拿大 8 个学术中心获得了包含 1993 年至 2008 年期间膀胱癌患者详细信息的机构根治性膀胱切除术数据库。共收集了 2287 例患者的数据，并将其合并到一个具有患者特征、病理特征、复发状态和生存状态的关系数据库中。患者年龄编码为<60 岁、60-69 岁、70-79 岁或≥80 岁。临床结局为 30 天死亡率、90 天死亡率、总生存（OS）、疾病特异性生存（DSS）和无复发生存（RFS）。使用逻辑回归和 Cox 比例风险回归分析来分析生存数据。
557（24.6%）、679（30.0%）、846（37.4%）和 181（8.0%）例患者<60 岁、60-69 岁、70-79 岁和≥80 岁。随着年龄的增加，新辅助化疗（P=0.0143）、辅助化疗（P<0.0001）和可控性尿流改道术（P<0.0001）的使用率降低，以及病理肿瘤分期更晚（P=0.0003）、阳性切缘（P<0.0001）和脉管侵犯（P=0.0335）的比例增加。与<60 岁的患者相比，多变量回归分析显示，年龄≥80 岁与 90 天死亡率（OR 2.98，95%CI 1.22-7.30）、OS（HR 2.03，95%CI 1.51-2.75）、DSS（HR 1.56，95%CI 1.09-2.24）和 RFS（HR 2.06，95%CI 1.57-2.70）独立相关。
根治性膀胱切除时年龄≥80 岁与不良生存结局独立相关。这些数据表明，在临床试验设计和预测生存的列线图中，应考虑到年龄的增长。
