Matthew J Bream1, Matthew J Maurice2, Joshua Altschuler1, Hui Zhu3, Robert Abouassaly4. 1. Urology Institute, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH. 2. Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH. 3. Louis Stokes Veterans Affairs Medical Center, Cleveland, OH. 4. Urology Institute, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH. Electronic address: robert.abouassaly@uhhospitals.org.
Abstract
OBJECTIVE: To assess national utilization patterns for cystectomy and nonsurgical treatments for elderly patients with muscle-invasive bladder cancer. METHODS: From the National Cancer Database, we identified patients ≥75 years old with T2-T4, non-metastatic urothelial carcinoma between 2003 and 2012. Patients were grouped by treatment: cystectomy, chemoradiation, or nonstandard treatment. Cochran-Armitage trend test was used to evaluate time trends for treatments and perioperative outcomes. Kaplan-Meier and Cox regression tests were used for overall survival analyses. RESULTS: Of 18,945 patients with muscle-invasive bladder cancer, 3898 (21%) underwent cystectomy. Cystectomy use increased from 14% in 2003 to 24% in 2012 (P <.01 for overall trend). Inpatient length of stay after cystectomy decreased over time (P = .02), whereas 30-day readmission and mortality rates remained stable (P = .86 and P = .73, respectively). Median overall survival (95% confidence interval [CI]) was 26.5 (23.1-28.9) months for cystectomy, 22.1 (20.1-24.2) months for chemoradiation, and 12.0 (11.3-12.7) months for nonstandard treatment (P <.01). The survival benefit of cystectomy compared with nonstandard treatment was seen regardless of comorbidity burden. In the Cox analysis, the hazard of death was 0.69 (95% CI 0.63-0.75, P <.01) for cystectomy and 0.75 (95% CI 0.70-0.82, P <.01) for chemoradiation, compared with nonstandard treatment. CONCLUSION: Cystectomy use is increasing in elderly patients, with stable or improved perioperative outcomes and improved survival compared with nonstandard treatment. These findings support continued use of cystectomy in appropriately selected elderly patients.
OBJECTIVE: To assess national utilization patterns for cystectomy and nonsurgical treatments for elderly patients with muscle-invasive bladder cancer. METHODS: From the National Cancer Database, we identified patients ≥75 years old with T2-T4, non-metastatic urothelial carcinoma between 2003 and 2012. Patients were grouped by treatment: cystectomy, chemoradiation, or nonstandard treatment. Cochran-Armitage trend test was used to evaluate time trends for treatments and perioperative outcomes. Kaplan-Meier and Cox regression tests were used for overall survival analyses. RESULTS: Of 18,945 patients with muscle-invasive bladder cancer, 3898 (21%) underwent cystectomy. Cystectomy use increased from 14% in 2003 to 24% in 2012 (P <.01 for overall trend). Inpatient length of stay after cystectomy decreased over time (P = .02), whereas 30-day readmission and mortality rates remained stable (P = .86 and P = .73, respectively). Median overall survival (95% confidence interval [CI]) was 26.5 (23.1-28.9) months for cystectomy, 22.1 (20.1-24.2) months for chemoradiation, and 12.0 (11.3-12.7) months for nonstandard treatment (P <.01). The survival benefit of cystectomy compared with nonstandard treatment was seen regardless of comorbidity burden. In the Cox analysis, the hazard of death was 0.69 (95% CI 0.63-0.75, P <.01) for cystectomy and 0.75 (95% CI 0.70-0.82, P <.01) for chemoradiation, compared with nonstandard treatment. CONCLUSION: Cystectomy use is increasing in elderly patients, with stable or improved perioperative outcomes and improved survival compared with nonstandard treatment. These findings support continued use of cystectomy in appropriately selected elderly patients.
Authors: Gianpaolo P Carpinito; Grayden S Cook; Aaron N Tverye; Samuel A Gold; Yair Lotan; Vitaly Margulis; Jeffrey M Howard Journal: Can Urol Assoc J Date: 2022-07 Impact factor: 2.052
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Authors: Vishnukamal Golla; Yong Shan; Hemalkumar B Mehta; Zachary Klaassen; Douglas S Tyler; Jacques Baillargeon; Ashish M Kamat; Stephen J Freedland; John L Gore; Karim Chamie; Yong-Fang Kuo; Stephen B Williams Journal: Eur Urol Open Sci Date: 2020-06-23