Rink M, Chun F K, Chromecki T F, Fajkovic H, Dahlem R, Fisch M, Shariat S F
Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg.
Urologe A. 2012 Jun;51(6):820-8. doi: 10.1007/s00120-011-2769-2.
Age is suggested to be the greatest single risk factor for developing urothelial carcinoma of the bladder (UCB). This review presents an overview of the incidence, prognosis, surgical and medical therapy of UCB in elderly patients (> 65 years).
Elderly patients have an approximate 11-fold increase in the incidence and a 15-fold increase in UCB mortality when compared to younger individuals. However, adequate surgical or medical treatment is less often or delayed offered to elderly patients. In properly selected cases, similar surgical outcomes and complication rates are reported in elderly patients, regardless of the type of urinary diversion. Application of perioperative systemic chemotherapy is dependent on physiologic deterioration and comorbidities. An adequate, restrictive case selection and early proactive postoperative rehabilitation are important factors to achieve good results.
In adequately selected elderly patients, radical cystectomy and urinary diversion as well as systemic chemotherapy are feasible, safe and efficacious treatment options for advanced UCB.
年龄被认为是发生膀胱尿路上皮癌（UCB）的最大单一风险因素。本综述概述了老年患者（>65岁）UCB的发病率、预后、手术及药物治疗情况。
与年轻个体相比，老年患者UCB的发病率约增加11倍，死亡率增加15倍。然而，老年患者接受充分手术或药物治疗的情况较少或延迟。在适当选择的病例中，无论尿流改道的类型如何，老年患者的手术结果和并发症发生率相似。围手术期全身化疗的应用取决于生理功能恶化和合并症情况。充分、严格的病例选择和早期积极的术后康复是取得良好效果的重要因素。
在适当选择的老年患者中，根治性膀胱切除术、尿流改道以及全身化疗是晚期UCB可行、安全且有效的治疗选择。
