Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Humanitas University, Milan, Italy.
BJU Int. 2024 Jan;133(1):63-70. doi: 10.1111/bju.16127. Epub 2023 Aug 2.
To evaluate the impact of age on oncological outcomes in a large contemporary cohort of patients with non-muscle-invasive bladder cancer (NMIBC) treated with adequate Bacillus Calmette-Guérin (BCG).
We performed an Institutional Review Board-approved retrospective study analysing patients with NMIBC treated with adequate BCG at our institution from 2000 to 2020. Adequate BCG was defined as per United States Food and Drug Administration (FDA) guidelines as being receipt of at least five of six induction BCG instillations with a minimum of two additional doses (of planned maintenance or of re-induction) of BCG instillations within a span of 6 months. The study's primary outcome was to determine if age >70 years was associated with progression to MIBC cancer or distant metastasis. The cumulative incidence method and the competing-risk regression analyses were used to investigate the association of advanced age (>70 years) with progression, high-grade (HG) recurrence and cancer-specific mortality (CSM).
Overall, data from 632 patients were analysed: 355 patients (56.2%) were aged ≤70 years and 277 (43.8%) were >70 years. Age >70 years did not adversely affect either cumulative incidence of progression or HG recurrence (P = 0.067 and P = 0.644, respectively). On competing-risk regression analyses, age >70 years did not emerge as an independent predictor of progression or HG recurrence (sub-standardised hazard ratio [SHR] 1.57, 95% confidence interval [CI] 0.87-2.81, P = 0.134; and SHR 1.05, 95% CI 0.77-1.44, P = 0.749). Not unexpectedly, patients in the older group did have higher overall mortality (P < 0.001) but not CSM (P = 0.057).
Age >70 years was not associated with adverse oncological outcomes in a large contemporary cohort of patients receiving adequate intravesical BCG for NMIBC. BCG should not be withheld from older patients seeking for bladder sparing options.
评估年龄对接受充分卡介苗（BCG）治疗的非肌肉浸润性膀胱癌（NMIBC）大当代队列患者的肿瘤学结果的影响。
我们进行了一项机构审查委员会批准的回顾性研究，分析了 2000 年至 2020 年在我们机构接受充分 BCG 治疗的 NMIBC 患者。充分 BCG 的定义是根据美国食品和药物管理局（FDA）的指南，接受至少六次诱导 BCG 灌注中的五次，并且在 6 个月的时间内接受至少两次额外剂量（计划维持或重新诱导）的 BCG 灌注。该研究的主要结果是确定年龄是否>70 岁与向肌层浸润性膀胱癌（MIBC）癌症或远处转移进展有关。累积发生率法和竞争风险回归分析用于研究高龄（>70 岁）与进展、高级别（HG）复发和癌症特异性死亡率（CSM）的相关性。
总体上，对 632 名患者的数据进行了分析：355 名患者（56.2%）年龄≤70 岁，277 名患者（43.8%）年龄>70 岁。年龄>70 岁并不影响进展或 HG 复发的累积发生率（P=0.067 和 P=0.644）。在竞争风险回归分析中，年龄>70 岁不是进展或 HG 复发的独立预测因素（亚标准风险比[SHR]1.57，95%置信区间[CI]0.87-2.81，P=0.134；SHR 1.05，95%CI 0.77-1.44，P=0.749）。不出所料，年龄较大组的患者总死亡率更高（P<0.001），但癌症特异性死亡率（CSM）没有差异（P=0.057）。
在接受充分膀胱内 BCG 治疗的 NMIBC 大当代队列中，年龄>70 岁与不良肿瘤学结果无关。对于寻求膀胱保留选择的老年患者，不应拒绝使用 BCG。
