Weill Medical College of Cornell University, 525 East 68th Street, Starr 900, New York, NY 10065, USA.
World J Urol. 2012 Dec;30(6):753-9. doi: 10.1007/s00345-011-0772-2. Epub 2011 Oct 19.
Small studies have suggested that older patients have worse outcomes following radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). We evaluated the association of patient age with clinical outcomes in a large multi-institutional RC series.
Data were collected from 4,429 patients treated with RC and lymphadenectomy for UCB without neoadjuvant chemotherapy. Age at RC was analyzed both as a continuous and categorical variable.
Higher age at RC, analyzed as a continuous or categorical variable, was associated with advanced pathologic stage (P < 0.001), higher tumor grade (P = 0.045), presence of lymphovascular invasion (P = 0.018), and positive soft-tissue surgical margin status (P = 0.004). Elderly patients were less likely to receive postoperative chemotherapy (P < 0.001). In multivariable analyses, higher age was associated with disease recurrence, cancer-specific, and overall mortality (P < 0.001). Patients ≥ 80 years had a significantly greater risk of cancer-specific mortality than patients <50 years (HR 1.763, P < 0.001). Age minimally improved the accuracy of a base model that included standard pathologic features for prediction of disease recurrence (+0.2-0.3%) and cancer-specific survival (+0.3%). Conversely, age improved the predictive accuracy for overall survival by a sizeable margin (+4.2-4.5%).
This large external validation study confirms that advanced patient age is minimally but significantly associated with worse prognosis after RC. Nevertheless, a large proportion of elderly patients benefitted from RC with curative intent. We need to improve our understanding of the reasons for the worse UCB outcomes in this growing segment of the population and to develop strategies to improve cancer care in the elderly.
一些小型研究表明，对于接受根治性膀胱切除术（RC）治疗的膀胱癌（UCB）患者，年龄较大的患者预后较差。我们评估了在大型多机构 RC 系列中，患者年龄与临床结局的关联。
从 4429 例接受 RC 和淋巴结切除术治疗 UCB 且未接受新辅助化疗的患者中收集数据。RC 时的年龄既作为连续变量又作为分类变量进行分析。
RC 时的年龄越高（作为连续或分类变量分析），与晚期病理分期（P < 0.001）、肿瘤分级越高（P = 0.045）、存在脉管侵犯（P = 0.018）和软组织手术切缘阳性（P = 0.004）相关。老年患者接受术后化疗的可能性较低（P < 0.001）。在多变量分析中，年龄越高与疾病复发、癌症特异性和总死亡率相关（P < 0.001）。≥80 岁的患者比<50 岁的患者癌症特异性死亡风险显著更高（HR 1.763，P < 0.001）。年龄仅略微提高了包含标准病理特征的基础模型预测疾病复发（+0.2-0.3%）和癌症特异性生存（+0.3%）的准确性。相反，年龄对总生存的预测准确性有显著提高（+4.2-4.5%）。
这项大型外部验证研究证实，患者年龄较高与 RC 后预后较差有一定但显著的相关性。然而，很大一部分老年患者仍从根治性手术中获益。我们需要深入了解在这一不断增长的人群中 UCB 结局较差的原因，并制定改善老年癌症护理的策略。
