Survival analysis of the treatment of muscle invasive bladder cancer in octogenarians

Abstract

Background: Radical cystectomy is a major surgical procedure that may be associated with perioperative complications, especially in patients of advanced age. Objective: To evaluate survival and complication rates and compare outcomes after treatment of muscle invasive bladder cancer in octogenarian patients in Ramathibodi Hospital. Materials and Methods: A retrospective analysis was performed after approval by the institutional ethical committee. Data from 807 bladder cancer patients between 2006 and 2016 were collected. Of these, 154 patients had muscle invasive bladder cancer, and 97 of these had adequate data for analyses. The primary outcome was overall survival. The log rank test was used to compare the treatments and outcomes of each age group. Cox regression analysis was used to predict factors related to survival outcome and presented with a Kaplan-Meier curve. Results: Of the 97 patients, 86 were treated by radical cystectomy and 11 were given non-surgical treatment. The five-year survival rate for the surgical treatment group was 66.51% (95% CI 46.86 to 80.29). The median survival time in the radical cystectomy group showed a longer median survival time than in the non-surgical treatment group, at 68 and 24 months, respectively. Patients that received radical cystectomy at age of 80 years or older had overall five-year survival time of 44.44% (95% CI 6.62 to 78.49). The median survival length of patients aged of 80 years or older in the radical cystectomy group and the non-surgical therapy group were 36 and 20 months, respectively. There was no statistically significant difference by hazard risk ratio (HR) 2.99 (p=0.106) between patients that received radical cystectomy in both age groups of less than 80 and 80 years or older. Elderly patients were more prone to have minor postoperative complications than younger patients, however, the major complication rates were similar in all ages. Conclusion: Radical cystectomy demonstrated better outcomes in median and five-year survival than the non-surgical treatment group. Octogenarian patients benefited from radical cystectomy, as did their younger counterparts. Radical cystectomy in the octogenarian group should be performed in well-selected patients and preoperative care should be improved to decrease the rate of complications.