Province-wide Outcomes of Radical Cystectomy and Use of Adjuvant Chemotherapy in the Elderly
CUA Online Library. Leveridge M. 06/25/13; 31314; MP-07.01
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Abstract
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Outcomes of Radical Cystectomy and Use of Adjuvant Chemotherapy in the Elderly
Introduction and Objective: Urothelial carcinoma of the bladder (UCB) occurs most commonly in the elderly. Radical cystectomy (RC) has been the standard treatment for muscle-invasive UCB, but is a morbid procedure. Evidence is lacking to guide the use of adjuvant chemotherapy (ACT) in this context. We sought to assess the outcomes of RC in elderly patients, and to assess the use and utility of ACT in these patients.
Methods: All patients with UCB undergoing RC for muscle-invasive disease in Ontario from 1994-2008 were identified using the Ontario Cancer Registry. Pathology reports were obtained and reviewed. Treatment and survival data were linked to the study database. Patients were classified using the following age groups: <70, 70-74, 75-79 and ≥80. Multivariate analysis was used to identify predictors of ACT use, and the Cox proportional hazards model was used to assess the effectiveness of ACT.
Results: We identified 2738 patients: age <70=1286, 70-74=617, 75-79=497, ≥80=338. Lymph node dissection was carried out less frequently in elderly patients (age <70=74%, 70-74=67%, 75-79=67%, ≥80=57%, p<0.0001). 30-day (1%, 2%, 3%, 6%, p<0.0001) and 90-day (5%, 9%, 11%, 15%, p<0.0001) mortality increased substantially with age. Overall (OS) and cancer-specific survival (CSS) at 5 years across the age groups was 36%, 28%, 21%, 21% (P<0.001) and 38%, 31%, 30%, 30% (P<0.001) respectively. ACT was used less frequently in elderly patients (30%, 15%, 9%, 3%, p<0.0001). The odds ratio for receiving ACT on multivariable analysis for patients aged ≥80 vs 70-74 was 0.16 [95%CI 0.08-0.32]. Among ACT patients, 87% under age 70 received cisplatin vs 70% aged ≥70 (p=0.003). In adjusted analyses ACT was associated with improved OS (Hazard Ratio (HR) 0.70 [0.59-0.84] for age <70 and HR 0.64[0.52-0.79] for ≥70) and CSS (HR 0.71 [0.58-0.86] for age <70 and HR 0.73 [0.58-0.92] for ≥70) across all age groups.
Conclusions: Cystectomy for muscle-invasive UCB is associated with significantly higher post-operative mortality in elderly patients. Lymph node dissection and use of ACT is lower in older patients, despite a substantial survival benefit across all age groups among those receiving ACT.
Introduction and Objective: Urothelial carcinoma of the bladder (UCB) occurs most commonly in the elderly. Radical cystectomy (RC) has been the standard treatment for muscle-invasive UCB, but is a morbid procedure. Evidence is lacking to guide the use of adjuvant chemotherapy (ACT) in this context. We sought to assess the outcomes of RC in elderly patients, and to assess the use and utility of ACT in these patients.
Methods: All patients with UCB undergoing RC for muscle-invasive disease in Ontario from 1994-2008 were identified using the Ontario Cancer Registry. Pathology reports were obtained and reviewed. Treatment and survival data were linked to the study database. Patients were classified using the following age groups: <70, 70-74, 75-79 and ≥80. Multivariate analysis was used to identify predictors of ACT use, and the Cox proportional hazards model was used to assess the effectiveness of ACT.
Results: We identified 2738 patients: age <70=1286, 70-74=617, 75-79=497, ≥80=338. Lymph node dissection was carried out less frequently in elderly patients (age <70=74%, 70-74=67%, 75-79=67%, ≥80=57%, p<0.0001). 30-day (1%, 2%, 3%, 6%, p<0.0001) and 90-day (5%, 9%, 11%, 15%, p<0.0001) mortality increased substantially with age. Overall (OS) and cancer-specific survival (CSS) at 5 years across the age groups was 36%, 28%, 21%, 21% (P<0.001) and 38%, 31%, 30%, 30% (P<0.001) respectively. ACT was used less frequently in elderly patients (30%, 15%, 9%, 3%, p<0.0001). The odds ratio for receiving ACT on multivariable analysis for patients aged ≥80 vs 70-74 was 0.16 [95%CI 0.08-0.32]. Among ACT patients, 87% under age 70 received cisplatin vs 70% aged ≥70 (p=0.003). In adjusted analyses ACT was associated with improved OS (Hazard Ratio (HR) 0.70 [0.59-0.84] for age <70 and HR 0.64[0.52-0.79] for ≥70) and CSS (HR 0.71 [0.58-0.86] for age <70 and HR 0.73 [0.58-0.92] for ≥70) across all age groups.
Conclusions: Cystectomy for muscle-invasive UCB is associated with significantly higher post-operative mortality in elderly patients. Lymph node dissection and use of ACT is lower in older patients, despite a substantial survival benefit across all age groups among those receiving ACT.
Outcomes of Radical Cystectomy and Use of Adjuvant Chemotherapy in the Elderly
Introduction and Objective: Urothelial carcinoma of the bladder (UCB) occurs most commonly in the elderly. Radical cystectomy (RC) has been the standard treatment for muscle-invasive UCB, but is a morbid procedure. Evidence is lacking to guide the use of adjuvant chemotherapy (ACT) in this context. We sought to assess the outcomes of RC in elderly patients, and to assess the use and utility of ACT in these patients.
Methods: All patients with UCB undergoing RC for muscle-invasive disease in Ontario from 1994-2008 were identified using the Ontario Cancer Registry. Pathology reports were obtained and reviewed. Treatment and survival data were linked to the study database. Patients were classified using the following age groups: <70, 70-74, 75-79 and ≥80. Multivariate analysis was used to identify predictors of ACT use, and the Cox proportional hazards model was used to assess the effectiveness of ACT.
Results: We identified 2738 patients: age <70=1286, 70-74=617, 75-79=497, ≥80=338. Lymph node dissection was carried out less frequently in elderly patients (age <70=74%, 70-74=67%, 75-79=67%, ≥80=57%, p<0.0001). 30-day (1%, 2%, 3%, 6%, p<0.0001) and 90-day (5%, 9%, 11%, 15%, p<0.0001) mortality increased substantially with age. Overall (OS) and cancer-specific survival (CSS) at 5 years across the age groups was 36%, 28%, 21%, 21% (P<0.001) and 38%, 31%, 30%, 30% (P<0.001) respectively. ACT was used less frequently in elderly patients (30%, 15%, 9%, 3%, p<0.0001). The odds ratio for receiving ACT on multivariable analysis for patients aged ≥80 vs 70-74 was 0.16 [95%CI 0.08-0.32]. Among ACT patients, 87% under age 70 received cisplatin vs 70% aged ≥70 (p=0.003). In adjusted analyses ACT was associated with improved OS (Hazard Ratio (HR) 0.70 [0.59-0.84] for age <70 and HR 0.64[0.52-0.79] for ≥70) and CSS (HR 0.71 [0.58-0.86] for age <70 and HR 0.73 [0.58-0.92] for ≥70) across all age groups.
Conclusions: Cystectomy for muscle-invasive UCB is associated with significantly higher post-operative mortality in elderly patients. Lymph node dissection and use of ACT is lower in older patients, despite a substantial survival benefit across all age groups among those receiving ACT.
Introduction and Objective: Urothelial carcinoma of the bladder (UCB) occurs most commonly in the elderly. Radical cystectomy (RC) has been the standard treatment for muscle-invasive UCB, but is a morbid procedure. Evidence is lacking to guide the use of adjuvant chemotherapy (ACT) in this context. We sought to assess the outcomes of RC in elderly patients, and to assess the use and utility of ACT in these patients.
Methods: All patients with UCB undergoing RC for muscle-invasive disease in Ontario from 1994-2008 were identified using the Ontario Cancer Registry. Pathology reports were obtained and reviewed. Treatment and survival data were linked to the study database. Patients were classified using the following age groups: <70, 70-74, 75-79 and ≥80. Multivariate analysis was used to identify predictors of ACT use, and the Cox proportional hazards model was used to assess the effectiveness of ACT.
Results: We identified 2738 patients: age <70=1286, 70-74=617, 75-79=497, ≥80=338. Lymph node dissection was carried out less frequently in elderly patients (age <70=74%, 70-74=67%, 75-79=67%, ≥80=57%, p<0.0001). 30-day (1%, 2%, 3%, 6%, p<0.0001) and 90-day (5%, 9%, 11%, 15%, p<0.0001) mortality increased substantially with age. Overall (OS) and cancer-specific survival (CSS) at 5 years across the age groups was 36%, 28%, 21%, 21% (P<0.001) and 38%, 31%, 30%, 30% (P<0.001) respectively. ACT was used less frequently in elderly patients (30%, 15%, 9%, 3%, p<0.0001). The odds ratio for receiving ACT on multivariable analysis for patients aged ≥80 vs 70-74 was 0.16 [95%CI 0.08-0.32]. Among ACT patients, 87% under age 70 received cisplatin vs 70% aged ≥70 (p=0.003). In adjusted analyses ACT was associated with improved OS (Hazard Ratio (HR) 0.70 [0.59-0.84] for age <70 and HR 0.64[0.52-0.79] for ≥70) and CSS (HR 0.71 [0.58-0.86] for age <70 and HR 0.73 [0.58-0.92] for ≥70) across all age groups.
Conclusions: Cystectomy for muscle-invasive UCB is associated with significantly higher post-operative mortality in elderly patients. Lymph node dissection and use of ACT is lower in older patients, despite a substantial survival benefit across all age groups among those receiving ACT.
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