Valérie Fonteyne1, Piet Ost2, Joaquim Bellmunt3, Jean Pierre Droz4, Pierre Mongiat-Artus5, Brant Inman6, Elena Paillaud7, Fred Saad8, Guillaume Ploussard9. 1. Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium. Electronic address: Valerie.fonteyne@uzgent.be. 2. Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium. 3. Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA. 4. Department of Cancer Environment Research Unit, Léon-Bérard Cancer Center, Claude-Bernard-Lyon University, Lyon, France. 5. Department of Urology, Saint-Louis Hospital, Paris, France. 6. Department of Urology, Duke University Medical Center, Durham, NC, USA. 7. Geriatric Department, CHU Henri Mondor, APHP, Créteil, France. 8. Prostate Cancer Research, Montreal Cancer Institute/CRCHUM, Centre de Hospitalier de Université de Montréal, Montréal, QC, Canada. 9. Urology Department, Saint Jean Languedoc Hospital, Toulouse, France.
Abstract
CONTEXT: The incidence of muscle invasive bladder cancer (MIBC) increases with age. With increased life expectancy the number of elderly MIBC patients is expected to increase. Existing guidelines on management of MIBC do not preclude curative treatments for elderly patients. However, it is necessary to assess the risks and benefits of a treatment to avoid overtreatment that results in decreased health-related quality of life without prolonging survival. OBJECTIVE: To report on overall survival (OS), cancer specific survival (CSS), and morbidity after curative treatment in elderly patients, defined as age >70 yr, with nonmetastatic MIBC and to compare this with the outcome of younger MIBC patients. EVIDENCE ACQUISITION: A systematic review was performed using Medline, PubMed, and Embase databases. Articles were included if they addressed one of the three research questions: Only articles including >100 patients and with a clear age-stratification were included. EVIDENCE SYNTHESIS: Forty-two articles were retrieved for review. No article directly addressed the use of geriatric assessment. OS and CSS worsen significantly with age both after radical cystectomy and radiotherapy regimens. While POM significantly increases with age, morbidity seems comparable between younger and older patients. CONCLUSIONS: Although a proportion of elderly patients with MIBC will benefit from curative treatment, we observed worse OS, CSS, and POM with age. The impact of age on late morbidity is less clear. Prospective studies evaluating geriatric assessments are critically needed to optimize MIBC management in the elderly. PATIENT SUMMARY: We performed a systematic review to evaluate the outcome and complication rate in elderly patients with muscle invasive bladder cancer. We observed that overall survival and cancer specific survival significantly decrease and perioperative mortality significantly increases with age. The impact of age on late morbidity is less clear. There is a need for geriatric assessments to select those patients that will benefit from curative treatment.
CONTEXT: The incidence of muscle invasive bladder cancer (MIBC) increases with age. With increased life expectancy the number of elderly MIBCpatients is expected to increase. Existing guidelines on management of MIBC do not preclude curative treatments for elderly patients. However, it is necessary to assess the risks and benefits of a treatment to avoid overtreatment that results in decreased health-related quality of life without prolonging survival. OBJECTIVE: To report on overall survival (OS), cancer specific survival (CSS), and morbidity after curative treatment in elderly patients, defined as age >70 yr, with nonmetastatic MIBC and to compare this with the outcome of younger MIBCpatients. EVIDENCE ACQUISITION: A systematic review was performed using Medline, PubMed, and Embase databases. Articles were included if they addressed one of the three research questions: Only articles including >100 patients and with a clear age-stratification were included. EVIDENCE SYNTHESIS: Forty-two articles were retrieved for review. No article directly addressed the use of geriatric assessment. OS and CSS worsen significantly with age both after radical cystectomy and radiotherapy regimens. While POM significantly increases with age, morbidity seems comparable between younger and older patients. CONCLUSIONS: Although a proportion of elderly patients with MIBC will benefit from curative treatment, we observed worse OS, CSS, and POM with age. The impact of age on late morbidity is less clear. Prospective studies evaluating geriatric assessments are critically needed to optimize MIBC management in the elderly. PATIENT SUMMARY: We performed a systematic review to evaluate the outcome and complication rate in elderly patients with muscle invasive bladder cancer. We observed that overall survival and cancer specific survival significantly decrease and perioperative mortality significantly increases with age. The impact of age on late morbidity is less clear. There is a need for geriatric assessments to select those patients that will benefit from curative treatment.
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