85 岁以上膀胱癌患者标准治疗与姑息治疗的比较：317 例初发肿瘤的多中心研究。
Comparison of standard vs. palliative management for bladder cancer in patients older than 85 years: multicenter study of 317 de novo tumors.
机构信息
Department of Urology, Hospital of Vall Hebron, Autonomous University of Barcelona, Barcelona, Spain.
Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain.
出版信息
Urol Oncol. 2020 Feb;38(2):40.e9-40.e15. doi: 10.1016/j.urolonc.2019.09.007. Epub 2019 Oct 2.
BACKGROUND
The peak incidence of bladder cancer (BCa) occurs at 85 years but data on treatment and outcome are sparse in this age group. We aimed to compare the outcomes of high-grade nonmuscle invasive BCa (HG NMIBC) and muscle invasive BCa (MIBC) treated with standard therapies vs. palliative management in patients >85 years.
METHODS
Retrospective multicenter study of 317 patients >85 years who underwent transurethral resection (TURB) for de novo BCa between 2014 and 2016. Standard management consisted in following EAU-guidelines and palliative in monitoring patients without applying oncological treatments after TURB. Low-grade tumors were not compared because all of them were considered to have followed a standard management.
RESULTS
Median age was 87 years (85-97). ASA-score was as follows: II, 34.7%; III, 52.1%; IV, 13.2%. Pathological examination showed: 86 Low-grade NMIBC (27.1%), 156 HG NMIBC (49.2%), and 75 MIBC (23.7%). Median follow-up of the series was 21 months (3-61) and median overall survival (OS) 29 (24-33). Among HG NMIBC, 77 patients (49.4%) received standard treatments (BCG, restaging TURB) and 79 (50.6%) palliative management. Among MIBC, 24 (32%) received standard management (cystectomy, radiotherapy, chemotherapy) and 51 (68%) palliative. Applying standard management in HG NMIBC was an independent prognostic factor of OS (44 months vs. 24, HR 1.95; P = 0.013) and decreased the emergency visit rate (33% vs. 43%). In MIBC, the type of management was not a related to OS (P = 0.439) and did not decrease the emergency visit rate (33% vs. 33%). ASA and Charlson-score were not predictors of OS in HG NMIBC (P = 0.368, P = 0.386) and MIBC (P = 0.511, P = 0.665).
CONCLUSIONS
Chronological age should not be a contraindication for applying standard therapies in NMIBC. In MIBC the survival is low regardless of the type of management. The lack of correlation between OS and ASA or Charlson-score raises the necessity of a geriatric assessment for selecting the best treatment strategy.
背景
膀胱癌（BCa）的发病高峰出现在 85 岁，但在这个年龄段的数据在治疗和结果方面非常有限。我们旨在比较> 85 岁接受标准治疗与姑息治疗的高分级非肌肉浸润性膀胱癌（HG NMIBC）和肌肉浸润性膀胱癌（MIBC）患者的结局。
方法
对 2014 年至 2016 年间接受经尿道膀胱肿瘤切除术（TURB）治疗初发 BCa 的 317 名> 85 岁患者进行回顾性多中心研究。标准治疗包括遵循欧洲泌尿外科学会（EAU）指南，对接受 TURB 治疗的患者进行姑息治疗，不进行肿瘤治疗。不比较低分级肿瘤，因为所有患者都被认为接受了标准治疗。
结果
中位年龄为 87 岁（85-97 岁）。ASA 评分如下：II 级，34.7%；III 级，52.1%；IV 级，13.2%。病理检查显示：86 例低分级 NMIBC（27.1%），156 例 HG NMIBC（49.2%）和 75 例 MIBC（23.7%）。该系列的中位随访时间为 21 个月（3-61），中位总生存期（OS）为 29 个月（24-33）。在 HG NMIBC 中，77 例（49.4%）患者接受标准治疗（BCG、再次 TURB），79 例（50.6%）接受姑息治疗。在 MIBC 中，24 例（32%）患者接受标准治疗（膀胱切除术、放疗、化疗），51 例（68%）患者接受姑息治疗。在 HG NMIBC 中，采用标准治疗是 OS 的独立预后因素（44 个月 vs. 24 个月，HR 1.95；P=0.013），并降低急诊就诊率（33% vs. 43%）。在 MIBC 中，治疗方式与 OS 无关（P=0.439），也不会降低急诊就诊率（33% vs. 33%）。ASA 和 Charlson 评分不是 HG NMIBC（P=0.368，P=0.386）和 MIBC（P=0.511，P=0.665）中 OS 的预测因素。
结论
年龄不应成为 NMIBC 中应用标准治疗的禁忌症。在 MIBC 中，无论治疗方式如何，生存率都很低。OS 与 ASA 或 Charlson 评分之间缺乏相关性，这就需要进行老年评估，以选择最佳的治疗策略。
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