Multicenter validation of the prognostic value of patient age in patients treated with radical cystectomy

Thomas F. Chromecki, Julian Mauermann, Eugene K. Cha, Robert S. Svatek, Harun Fajkovic, Pierre I. Karakiewicz, Yair Lotan, Derya Tilki, Patrick J. Bastian, Bjoern G. Volkmer, Francesco Montorsi, Wassim Kassouf, Giacomo Novara, Hans Martin Fritsche, Vincenzo Ficarra, Christian G. Stief, Colin P. Dinney, Eila Skinner, Karl Pummer, Yves FradetShahrokh F. Shariat

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Purpose: Small studies have suggested that older patients have worse outcomes following radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). We evaluated the association of patient age with clinical outcomes in a large multi-institutional RC series. Methods: Data were collected from 4,429 patients treated with RC and lymphadenectomy for UCB without neoadjuvant chemotherapy. Age at RC was analyzed both as a continuous and categorical variable. Results: Higher age at RC, analyzed as a continuous or categorical variable, was associated with advanced pathologic stage (P < 0. 001), higher tumor grade (P = 0. 045), presence of lymphovascular invasion (P = 0. 018), and positive soft-tissue surgical margin status (P = 0. 004). Elderly patients were less likely to receive postoperative chemotherapy (P < 0. 001). In multivariable analyses, higher age was associated with disease recurrence, cancer-specific, and overall mortality (P < 0. 001). Patients ≥80 years had a significantly greater risk of cancer-specific mortality than patients <50 years (HR 1. 763, P < 0. 001). Age minimally improved the accuracy of a base model that included standard pathologic features for prediction of disease recurrence (+0. 2-0. 3%) and cancer-specific survival (+0. 3%). Conversely, age improved the predictive accuracy for overall survival by a sizeable margin (+4. 2-4. 5%). Conclusions: This large external validation study confirms that advanced patient age is minimally but significantly associated with worse prognosis after RC. Nevertheless, a large proportion of elderly patients benefitted from RC with curative intent. We need to improve our understanding of the reasons for the worse UCB outcomes in this growing segment of the population and to develop strategies to improve cancer care in the elderly.

Original languageEnglish (US)
Pages (from-to)753-759
Number of pages7
JournalWorld Journal of Urology
Volume30
Issue number6
DOIs
StatePublished - Dec 2012

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Cystectomy
Urinary Bladder
Neoplasms
Carcinoma
Recurrence
Drug Therapy
Survival
Mortality
Validation Studies
Lymph Node Excision
Population

Keywords

  • Age
  • Prognosis
  • Radical cystectomy
  • Survival
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Chromecki, T. F., Mauermann, J., Cha, E. K., Svatek, R. S., Fajkovic, H., Karakiewicz, P. I., ... Shariat, S. F. (2012). Multicenter validation of the prognostic value of patient age in patients treated with radical cystectomy. World Journal of Urology, 30(6), 753-759. https://doi.org/10.1007/s00345-011-0772-2

Multicenter validation of the prognostic value of patient age in patients treated with radical cystectomy. / Chromecki, Thomas F.; Mauermann, Julian; Cha, Eugene K.; Svatek, Robert S.; Fajkovic, Harun; Karakiewicz, Pierre I.; Lotan, Yair; Tilki, Derya; Bastian, Patrick J.; Volkmer, Bjoern G.; Montorsi, Francesco; Kassouf, Wassim; Novara, Giacomo; Fritsche, Hans Martin; Ficarra, Vincenzo; Stief, Christian G.; Dinney, Colin P.; Skinner, Eila; Pummer, Karl; Fradet, Yves; Shariat, Shahrokh F.

In: World Journal of Urology, Vol. 30, No. 6, 12.2012, p. 753-759.

Research output: Contribution to journalArticle

Chromecki, TF, Mauermann, J, Cha, EK, Svatek, RS, Fajkovic, H, Karakiewicz, PI, Lotan, Y, Tilki, D, Bastian, PJ, Volkmer, BG, Montorsi, F, Kassouf, W, Novara, G, Fritsche, HM, Ficarra, V, Stief, CG, Dinney, CP, Skinner, E, Pummer, K, Fradet, Y & Shariat, SF 2012, 'Multicenter validation of the prognostic value of patient age in patients treated with radical cystectomy', World Journal of Urology, vol. 30, no. 6, pp. 753-759. https://doi.org/10.1007/s00345-011-0772-2
Chromecki, Thomas F. ; Mauermann, Julian ; Cha, Eugene K. ; Svatek, Robert S. ; Fajkovic, Harun ; Karakiewicz, Pierre I. ; Lotan, Yair ; Tilki, Derya ; Bastian, Patrick J. ; Volkmer, Bjoern G. ; Montorsi, Francesco ; Kassouf, Wassim ; Novara, Giacomo ; Fritsche, Hans Martin ; Ficarra, Vincenzo ; Stief, Christian G. ; Dinney, Colin P. ; Skinner, Eila ; Pummer, Karl ; Fradet, Yves ; Shariat, Shahrokh F. / Multicenter validation of the prognostic value of patient age in patients treated with radical cystectomy. In: World Journal of Urology. 2012 ; Vol. 30, No. 6. pp. 753-759.
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T1 - Multicenter validation of the prognostic value of patient age in patients treated with radical cystectomy

AU - Chromecki, Thomas F.

AU - Mauermann, Julian

AU - Cha, Eugene K.

AU - Svatek, Robert S.

AU - Fajkovic, Harun

AU - Karakiewicz, Pierre I.

AU - Lotan, Yair

AU - Tilki, Derya

AU - Bastian, Patrick J.

AU - Volkmer, Bjoern G.

AU - Montorsi, Francesco

AU - Kassouf, Wassim

AU - Novara, Giacomo

AU - Fritsche, Hans Martin

AU - Ficarra, Vincenzo

AU - Stief, Christian G.

AU - Dinney, Colin P.

AU - Skinner, Eila

AU - Pummer, Karl

AU - Fradet, Yves

AU - Shariat, Shahrokh F.

PY - 2012/12

Y1 - 2012/12

N2 - Purpose: Small studies have suggested that older patients have worse outcomes following radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). We evaluated the association of patient age with clinical outcomes in a large multi-institutional RC series. Methods: Data were collected from 4,429 patients treated with RC and lymphadenectomy for UCB without neoadjuvant chemotherapy. Age at RC was analyzed both as a continuous and categorical variable. Results: Higher age at RC, analyzed as a continuous or categorical variable, was associated with advanced pathologic stage (P < 0. 001), higher tumor grade (P = 0. 045), presence of lymphovascular invasion (P = 0. 018), and positive soft-tissue surgical margin status (P = 0. 004). Elderly patients were less likely to receive postoperative chemotherapy (P < 0. 001). In multivariable analyses, higher age was associated with disease recurrence, cancer-specific, and overall mortality (P < 0. 001). Patients ≥80 years had a significantly greater risk of cancer-specific mortality than patients <50 years (HR 1. 763, P < 0. 001). Age minimally improved the accuracy of a base model that included standard pathologic features for prediction of disease recurrence (+0. 2-0. 3%) and cancer-specific survival (+0. 3%). Conversely, age improved the predictive accuracy for overall survival by a sizeable margin (+4. 2-4. 5%). Conclusions: This large external validation study confirms that advanced patient age is minimally but significantly associated with worse prognosis after RC. Nevertheless, a large proportion of elderly patients benefitted from RC with curative intent. We need to improve our understanding of the reasons for the worse UCB outcomes in this growing segment of the population and to develop strategies to improve cancer care in the elderly.

AB - Purpose: Small studies have suggested that older patients have worse outcomes following radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). We evaluated the association of patient age with clinical outcomes in a large multi-institutional RC series. Methods: Data were collected from 4,429 patients treated with RC and lymphadenectomy for UCB without neoadjuvant chemotherapy. Age at RC was analyzed both as a continuous and categorical variable. Results: Higher age at RC, analyzed as a continuous or categorical variable, was associated with advanced pathologic stage (P < 0. 001), higher tumor grade (P = 0. 045), presence of lymphovascular invasion (P = 0. 018), and positive soft-tissue surgical margin status (P = 0. 004). Elderly patients were less likely to receive postoperative chemotherapy (P < 0. 001). In multivariable analyses, higher age was associated with disease recurrence, cancer-specific, and overall mortality (P < 0. 001). Patients ≥80 years had a significantly greater risk of cancer-specific mortality than patients <50 years (HR 1. 763, P < 0. 001). Age minimally improved the accuracy of a base model that included standard pathologic features for prediction of disease recurrence (+0. 2-0. 3%) and cancer-specific survival (+0. 3%). Conversely, age improved the predictive accuracy for overall survival by a sizeable margin (+4. 2-4. 5%). Conclusions: This large external validation study confirms that advanced patient age is minimally but significantly associated with worse prognosis after RC. Nevertheless, a large proportion of elderly patients benefitted from RC with curative intent. We need to improve our understanding of the reasons for the worse UCB outcomes in this growing segment of the population and to develop strategies to improve cancer care in the elderly.

KW - Age

KW - Prognosis

KW - Radical cystectomy

KW - Survival

KW - Urothelial carcinoma

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