Back to Search Start Over

Assessing the safety of bladder-preserving therapy as an alternative to surgical intervention in elderly patients with muscle invasive bladder cancer.

Authors :
Koller CR
Greenberg JW
Natale C
Krane LS
Source :
Urologia [Urologia] 2024 Nov; Vol. 91 (4), pp. 701-708. Date of Electronic Publication: 2024 Jul 26.
Publication Year :
2024

Abstract

Background: There is interest in using bladder-preserving therapy as an alternative definitive therapy for muscle invasive bladder cancer in certain high-risk groups such as the elderly.<br />Objective: To determine if bladder-preserving therapy represents a safer alternative to surgical intervention in elderly patients with muscle invasive bladder cancer.<br />Methods: We surveyed the Surveillance, Epidemiology and End Results database (SEER) for cases of non-metastasized malignant bladder cancer in patients aged 80+. Survival outcomes with radical cystectomy (RC) with or without chemotherapy were compared to those after chemotherapy and radiation without cystectomy. We performed log-rank tests and Kaplan-Meier and cox regression and hazard analyses before and after propensity score matching.<br />Results: A total of 2995 patients were identified, with 49.98% treated with RC only, 8.65% treated with RC/chemotherapy, and 41.37% treated with chemotherapy and radiation without RC. Median overall survival for the RC only, RC/chemotherapy and chemotherapy/radiation groups were 31.4, 44.1, and 24.6 months, respectively. On multivariate analysis, hazard ratios (reference: RC/chemotherapy group) were RC Only (HR = 1.408 (95% CI 1.188-1.669), p  < 0.0001) and chemotherapy/radiation (HR = 1.650 (95% CI 1.390-1.959), p  < 0.0001). After matching the chemotherapy/radiation and RC/chemotherapy groups, the former continued to show survival hazard (HR = 1.744 (95% CI 1.414-2.155), p  < 0.0001).<br />Conclusions: Octogenarians should be offered definitive local therapy for their localized bladder cancer including RC and chemotherapy. Bladder-sparing alternatives should be reserved for patients unfit for surgery.<br />Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. L. Spencer Krane reports a relationship with HIFU prostate services, AngioDynamics Inc, and MD Health Inc that includes consulting or advisory. No other authors report a conflict of interest.

Details

Language :
English
ISSN :
1724-6075
Volume :
91
Issue :
4
Database :
MEDLINE
Journal :
Urologia
Publication Type :
Academic Journal
Accession number :
39058262
Full Text :
https://doi.org/10.1177/03915603241265828