Category: Clinical Oncology: Outcomes & Complications

MP18-11 - Advanced Age Does Not Predict Survival in Patients Undergoing Radical Cystectomy for Muscle-Invasive Bladder Cancer

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective : Given the perioperative morbidity associated with radical cystectomy (RC), alternative treatment options are considered for elderly patients with muscle-invasive bladder cancer (MIBC).  We evaluated the overall (OS) and disease-free survival (DFS) of patients with MIBC who underwent RC at our institution, based on age-stratified cohorts.


Methods : We identified 344 patients who underwent RC for MIBC from January 2010 to December 2016.  Cohorts were stratified by age (<60, 60-69, 70-79, and 80+).  Kaplan-Meier estimated survival curves were generated for OS and DFS.  Cox proportional hazards analysis was performed to identify factors that predicted survival.


Results : Estimated survival curves are provided in Figure 1.  No significant differences were noted in OS (p=0.39) and DFS (p=0.25) across the various age groups.  Multivariate analysis controlling for age, histology, receipt of neoadjuvant chemotherapy, and comorbidity demonstrated that pathologic stage was the strongest independent predictor of survival.  For OS, HR = 11.1, 7.3, and 3.7 for T4, T3, and T2 disease (p<0.01).  For DFS, HR = 20.6, 14.6, and 4.2 for T4, T3, and T2 disease (p<0.01).  Importantly length of stay (p=0.39) and 30-day complication rates (p=0.14) were not significantly different among the various age groups.


Conclusions : In our experience, increasing age was not a predictor of OS or DFS for patients receiving RC for MIBC.  For patients with MIBC, clinicians should not discriminatorily offer RC on the basis of advanced age.  

Eric H. Kim

Assistant Professor
Washington University in St. Louis
St. Louis, Missouri

Eric H. Kim, M.D., is an Assistant Professor of Surgery in the Division of Urologic Surgery at Washington University School of Medicine in St. Louis. Clinically, he specializes in robotic surgery for urologic cancers. His research focuses on imaging in prostate cancer.

Joel Vetter

Statistician
Washington University in St. Louis
Saint Louis, Missouri

Yifan Meng

St. Louis, Missouri

Alex Parker

St. Louis, Missouri

Gerald Andriole

Chief of Urologic Surgery
Washington University School of Medicine
St. Louis, Missouri

Gerald L. Andriole, Jr., MD
Robert K. Royce Distinguished Professor
Chief of Urologic Surgery
Siteman Cancer Center
Barnes-Jewish Hospital
Washington University School of Medicine
St. Louis, Missouri

Gerald L. Andriole, Jr., MD, is the Robert K. Royce Distinguished Professor and Chief of Urologic Surgery at Barnes-Jewish Hospital, the Siteman Cancer Center and Washington University School of Medicine in St. Louis, Missouri.

Dr. Andriole received his medical degree from Jefferson Medical College in Philadelphia, Pennsylvania. He trained in surgery at Strong Memorial Hospital and the University of Rochester and completed urology residency at Brigham and Women’s Hospital and Harvard Medical School. Subsequently, he was a fellow in Urologic Oncology at the National Cancer Institute in Bethesda, Maryland.

Dr. Andriole has over 30 years of consistent contributions in the areas of BPH and prostate cancer screening and prevention research. He has contributed well over 300 peer-reviewed publications and serves on the editorial boards of several prestigious journals. He is Chairman of the Prostate Committee of the National Cancer Institute’s Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial and of the Steering Committee of the REDUCE Prostate Cancer Prevention Trial. He is a member of the American Urological Association, American Association for Cancer Research, the American Society of Clinical Oncology, the Prostate Cancer Early Detection Panel of the National Comprehensive Cancer Network, American Surgical Association and the American Association of Genitourinary Surgeons among other societies.