Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.
Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Investig Clin Urol. 2016 Jun;57 Suppl 1(Suppl 1):S26-35. doi: 10.4111/icu.2016.57.S1.S26. Epub 2016 May 27.
As the population ages and life expectancy increases in the human population, more individuals will be diagnosed with bladder cancer (BC). The definition of who is elderly is likely to change in the future from the commonly used cut-off of ≥75 years of age. Physiological rather than chronological age is key. BC care in the elderly is likely to become a very common problem in daily practice. Concerns have been raised that senior BC patients are not given treatments that could cure their disease. Clinicians lack quantitative and reliable estimates of competing mortality risks when considering treatments for BC. Majority of patients diagnosed with BC are elderly, making treatment decisions complex with their increasing number of comorbidities. A multidisciplinary approach to these patients may be a way to incorporate discussion from various disciplines regarding treatment options available. Here we review various treatment options for elderly patients with muscle invasive BC and nonmuscle invasive BC. We include differences in treatments from robotic versus open radical cystectomy, various urinary diversion techniques, chemotherapy, radiation therapy and combination treatments. In clinical practice, treatment decisions for elderly patients should be done on a case-by-case basis, tailored to each patient with their specific histories and comorbidities considered. Some healthy elderly patients may be better candidates for extensive curative treatments than their younger counterparts. This implies that these important, life-altering decisions cannot be solely based on age as many other factors can affect patient survival outcomes.
随着人口老龄化和人类预期寿命的延长，更多的人将被诊断出患有膀胱癌 (BC)。老年人的定义可能会发生变化，未来可能会从常用的 ≥75 岁年龄界限改变。关键是生理年龄而不是实际年龄。老年人膀胱癌的治疗在未来很可能会成为日常实践中的一个常见问题。有人担心，老年膀胱癌患者没有接受可能治愈其疾病的治疗。临床医生在考虑膀胱癌的治疗方法时，缺乏对竞争死亡风险的定量和可靠估计。大多数被诊断患有膀胱癌的患者是老年人，由于他们的合并症越来越多，治疗决策变得非常复杂。对这些患者采用多学科方法可能是一种将来自不同学科的治疗选择进行讨论的方法。在这里，我们回顾了肌层浸润性膀胱癌和非肌层浸润性膀胱癌老年患者的各种治疗选择。我们包括了机器人与开放性根治性膀胱切除术、各种尿路改道术、化疗、放疗和联合治疗之间的差异。在临床实践中，应根据具体情况对老年患者的治疗做出决定，针对每位患者的具体病史和合并症进行个体化治疗。一些健康的老年患者可能比年轻患者更适合接受广泛的治愈性治疗。这意味着这些重要的、改变生活的决策不能仅仅基于年龄，因为许多其他因素会影响患者的生存结果。
