Takahiko Hara1,2, Hideyasu Matsuyama3, Yoriaki Kamiryo4, Shigeaki Hayashida5, Norio Yamamoto6, Takahito Nasu5, Keiji Joko7, Yoshikazu Baba8, Akinobu Suga9, Mitsutaka Yamamoto10, Akihiko Aoki11, Kimio Takai12, Satoru Yoshihiro13, Motohiko Konishi14, Sigeru Sakano15, Katsuhiko Imoto16, Yasuhide Tei17, Shiro Yamaguchi18, Seiji Yano19. 1. Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan. hara-t@masuda.jrc.or.jp. 2. Department of Urology, Masuda Red Cross Hospital, I 103-1 Otoyoshi-chou, Masuda, Shimane, 698-8501, Japan. hara-t@masuda.jrc.or.jp. 3. Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan. 4. Department of Urology, Shimonoseki Saisekai Toyoura Hospital, 7-3 Kogushi, Toyoura, Shiomonoseki, Yamaguchi, 759-6302, Japan. 5. Department of Urology and Nephrology, Tokuyama Central Hospital, 1-1 Takada, Shunan, Yamaguchi, 745-8522, Japan. 6. Department of Urology, Tokuyama Medical Association Hospital, 6-28 Higashiyama, Shunan, Yamaguchi, 745-0846, Japan. 7. Department of Urology, Saiseikai Yamaguchi General Hospital, 2-11 Midorimachi, Yamaguchi, Yamaguchi, 753-0078, Japan. 8. Department of Urology, Shuto General Hospital, 1000-1 Kokaisaku, Yanai, Yamaguchi, 742-0032, Japan. 9. Department of Urology, Yamaguchi Red Cross Hospital, 53-1 Hachimanbaba, Yamaguchi, Yamaguchi, 753-8519, Japan. 10. Department of Urology, Yamaguchi Grand Medical Center, Hofu, 77 Osaki, Yamaguchi, 747-8511, Japan. 11. Department of Urology, Masuda Red Cross Hospital, I 103-1 Otoyoshi-chou, Masuda, Shimane, 698-8501, Japan. 12. Department of Urology, Saiseikai Shimonoseki General Hospital, 8-5-1 Yasuoka, Shomonoseki, Yamaguchi, 759-6603, Japan. 13. Department of Urology, Shimonoseki City Hospital, 1-13-1 Koyo, Shimonoseki, Yamaguchi, 750-8520, Japan. 14. Department of Urology, Shunan City Shinnanyo Hospital, 2-3-15 Miyanomae, Syunan, Yamaguchi, 746-0017, Japan. 15. Department of Urology, Kokura Memorial Hospital, 3-2-1 Asano, Kokura-ku, Kitakyusyu, Fukuoka, 802-8555, Japan. 16. Department of Urology, Hikari Municipal Hikari General Hospital, 2-10-1 Nijigahama, Hikari, Yamaguchi, 743-0022, Japan. 17. Department of Urology, Kanmon Medical Center, 1-1-1 Chofusotoura-cho, Shimonoseki, Yamaguchi, 752-8510, Japan. 18. Department of Urology, Shimonoseki Medical Center, 3-3-8 Kamishinchi-cho, Shimonoseki, Yamaguchi, 750-0061, Japan. 19. Department of Urology, Ogori Daiichi General Hospital, 862-3 Ogori Shimogo, Yamaguchi, Yamaguchi, 754-0002, Japan.
Abstract
BACKGROUND: The standard of care for treatment of localized muscle-invasive bladder cancer (MIBC) is radical cystectomy (RC). The patient's condition may affect management of MIBC, especially for elderly patients with more comorbid conditions and lower performance status. We retrospectively evaluated the association between clinicopathological data and outcomes for patients with bladder cancer (BCa) treated by RC. We particularly focused on elderly patients (age ≥75 years) with BCa. METHODS: We enrolled 254 patients with BCa who underwent RC and urinary diversion with or without pelvic lymph node dissection. We assessed perioperative complications and clinicopathological data affecting overall survival (OS) after RC. RESULTS: The incidence of complications was 34.3 %, and that of severe complications (Grade 3-5) was 16.5 %. The elderly group experienced more severe complications (P = 0.042). Median follow-up was 43.0 months (range 1.0-155.6). Five-year OS after RC was 62.7 %. OS after RC was no different for patients aged ≥75 and <75 years (P = 0.983). Multivariate analysis revealed that Eastern Cooperative Oncology Group performance status (ECOG PS) and hemoglobin (Hb) concentration were associated with all-cause mortality. Hb concentration of <12.6 g/dl was an independent predictor of a poor prognosis among elderly patients after RC for BCa. ECOG PS >1 tended to affect OS after RC in this group. CONCLUSION: ECOG PS and preoperative Hb concentration were useful for prediction of clinical outcome after RC for elderly patients. This information may aid decision-making in the treatment of elderly patients with MIBC.
BACKGROUND: The standard of care for treatment of localized muscle-invasive bladder cancer (MIBC) is radical cystectomy (RC). The patient's condition may affect management of MIBC, especially for elderly patients with more comorbid conditions and lower performance status. We retrospectively evaluated the association between clinicopathological data and outcomes for patients with bladder cancer (BCa) treated by RC. We particularly focused on elderly patients (age ≥75 years) with BCa. METHODS: We enrolled 254 patients with BCa who underwent RC and urinary diversion with or without pelvic lymph node dissection. We assessed perioperative complications and clinicopathological data affecting overall survival (OS) after RC. RESULTS: The incidence of complications was 34.3 %, and that of severe complications (Grade 3-5) was 16.5 %. The elderly group experienced more severe complications (P = 0.042). Median follow-up was 43.0 months (range 1.0-155.6). Five-year OS after RC was 62.7 %. OS after RC was no different for patients aged ≥75 and <75 years (P = 0.983). Multivariate analysis revealed that Eastern Cooperative Oncology Group performance status (ECOG PS) and hemoglobin (Hb) concentration were associated with all-cause mortality. Hb concentration of <12.6 g/dl was an independent predictor of a poor prognosis among elderly patients after RC for BCa. ECOG PS >1 tended to affect OS after RC in this group. CONCLUSION: ECOG PS and preoperative Hb concentration were useful for prediction of clinical outcome after RC for elderly patients. This information may aid decision-making in the treatment of elderly patients with MIBC.
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