Comparison of Outcomes between Standard and Palliative Management for High Grade Non-Muscle Invasive Bladder Cancer in Patients Older than 85 Years

Albert Carrion, Fernando Díaz, Carles Raventós, Fernando Lozano, Adrià Piñero, Juan Morote

Research output: Contribution to journalArticleResearch

Abstract

© 2019 S. Karger AG, Basel. Objectives: To analyze outcomes of patients > 85 years with de novo bladder cancer (BCa). To compare outcomes of high grade (HG) non-muscle invasive BCa (NMIBC) treated with standard therapies versus palliative management. Methods: Retrospective revision of 65 patients > 85 years who underwent transurethral resection of the bladder (TURB) for de novo BCa. According to functional status each patient was offered a standard or palliative management after TURB. Results: Median age was 87.3 years (85.2-95.4) and 51 were men (78.5%). Twenty-eight (43%) were American Society of Anesthesiologists (ASA) II and 37 ASA III-IV (57%). Pathological examination: 29 pTx-pTa (44.6%), 28 pT1 (43.1%) and 8 pT2 (12.3%). Twenty were low grade (30.8%) and 45 HG (69.2%). Among 37 HG NMIBC patients, 43% followed standard therapies (BCG or re-staging TURB + BCG), and 57% a palliative management (no oncological treatments). With a median follow-up of 20 months (3-108), 2 (12.5%) died in standard group compared to 11 (52.4%) in palliative. In univariate analysis, age (<italic>p</italic> = 0.024), stage (<italic>p</italic> = 0.009), and standard management (<italic>p</italic> = 0.019) were related to overall survival (OS). In multivariate, standard management was an independent prognostic factor of OS (hazard ratio 0.164, 95% CI 0.036-0.744, <italic>p</italic> = 0.048). Conclusions: Advanced age should not be a contraindication for standard therapies in BCa. A geriatric assessment could identify patients who may benefit from adjuvant therapies after TURB.
Original languageEnglish
Pages (from-to)277-283
JournalUrologia Internationalis
Volume102
DOIs
Publication statusPublished - 1 Apr 2019

Keywords

  • Bacillus calmette-gu-rin
  • Bladder cancer
  • Complication
  • Intravesical instillation
  • Transurethral resection

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