OBJECTIVE: Bacille Calmette-Guérin (BCG) is recommended as adjunctive therapy among patients with high-risk nonmuscle-invasive bladder cancer (BC). Given that immune response is attenuated with age, we set out to determine the impact of age on response to BCG. MATERIALS AND METHODS: We searched our prospective bladder information system and limited our search to patients with incident BC completely resected at transurethral resection (TUR) who completed a full induction course of BCG. We then analyzed the impact of age on outcome. Age was analyzed both dichotomously (greater or less than 75 years) as well as by 10-year increments. The main outcomes were recurrence or progression-free survival. Log-rank and multivariable Cox proportional-hazard analyses, adjusting for clinical and pathologic features (age, multifocality, pathologic stage, grade and associated carcinoma in situ, maintenance, and restaging) were used. RESULTS: This cohort included 238 patients. Baseline parameters were similar aside from tumor number. Progression-free survival differed between age groups when examined either dichotomously or via 10-year increments. The 2-year progression-free survival was 87% among patients <75 years vs 65% in patients >75 years (log rank P <.001). An age-dependent trend was noted when analyzed by 10-year increment (log-rank for trend P = .011). On multivariable analysis, age was an independent risk factor for progression (HR = 2.9, 95% CI 1.7-4.9). Recurrence-free survival was similar among age strata. CONCLUSION: We demonstrated that advanced age is associated with higher progression rates despite BCG. The care of BC in the elderly population is of increasing concern and should be addressed in a prospective clinical study.
OBJECTIVE: Bacille Calmette-Guérin (BCG) is recommended as adjunctive therapy among patients with high-risk nonmuscle-invasive bladder cancer (BC). Given that immune response is attenuated with age, we set out to determine the impact of age on response to BCG. MATERIALS AND METHODS: We searched our prospective bladder information system and limited our search to patients with incident BC completely resected at transurethral resection (TUR) who completed a full induction course of BCG. We then analyzed the impact of age on outcome. Age was analyzed both dichotomously (greater or less than 75 years) as well as by 10-year increments. The main outcomes were recurrence or progression-free survival. Log-rank and multivariable Cox proportional-hazard analyses, adjusting for clinical and pathologic features (age, multifocality, pathologic stage, grade and associated carcinoma in situ, maintenance, and restaging) were used. RESULTS: This cohort included 238 patients. Baseline parameters were similar aside from tumor number. Progression-free survival differed between age groups when examined either dichotomously or via 10-year increments. The 2-year progression-free survival was 87% among patients <75 years vs 65% in patients >75 years (log rank P <.001). An age-dependent trend was noted when analyzed by 10-year increment (log-rank for trend P = .011). On multivariable analysis, age was an independent risk factor for progression (HR = 2.9, 95% CI 1.7-4.9). Recurrence-free survival was similar among age strata. CONCLUSION: We demonstrated that advanced age is associated with higher progression rates despite BCG. The care of BC in the elderly population is of increasing concern and should be addressed in a prospective clinical study.
Authors: Wojciech Krajewski; Oscar Rodríguez Faba; Alberto Breda; Francesca Pisano; Sławomir Poletajew; Andrzej Tukiendorf; Romuald Zdrojowy; Anna Kołodziej; Juan Palou Journal: World J Urol Date: 2020-02-18 Impact factor: 4.226
Authors: Álvaro Padrón; Vincent Hurez; Harshita B Gupta; Curtis A Clark; Sri Lakshmi Pandeswara; Bin Yuan; Robert S Svatek; Mary Jo Turk; Justin M Drerup; Rong Li; Tyler J Curiel Journal: Exp Gerontol Date: 2018-01-08 Impact factor: 4.032
Authors: B Calò; F Sanguedolce; F Fortunato; G Stallone; N d'Altilia; M Chirico; U Falagario; Vito Mancini; G Carrieri; L Cormio Journal: Medicine (Baltimore) Date: 2019-08 Impact factor: 1.817