Shangxun Xie1, Zihan Zhao1, Baofu Feng1, Shiwei Zhang1, Gutian Zhang1, Xiaogong Li1, Hongqian Guo2, Rong Yang3. 1. Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China. 2. Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China. dr.ghq@163.com. 3. Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China. doctoryr@gmail.com.
Abstract
BACKGROUND: Radical cystectomy (RC) is the standard treatment for bladder cancer, but the safety and efficacy of this treatment for elderly people need to be considered. We compare perioperative data and survival outcomes between elderly (≥80 years) and younger (<80 years) patients undergoing robot-assisted radical cystectomy (RARC). METHODS: We reviewed demographic, perioperative clinical and follow-up data of 190 consecutive patients with urothelial carcinoma of bladder who received RARC from May 2015 to December 2018 in Nanjing Drum Tower Hospital. The patients were divided into 2 groups by age: ≥80 years and <80 years. Perioperative outcomes were compared between 2 groups. Logistic regression method was used to analyze the factors that may affect preoperative complications. Cox regression model was employed to analyze the factors affecting 3-year overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS). RESULTS: Of the 190 patients, 44 (23.2%) were octogenarians. The elderly patients did not statistically differ from younger patients in most of the demographic, perioperative, and pathological information. American Society of Anesthesiologists (ASA) score (p=0.045) and Charlson comorbidity index (CCI) (p=0.035) could predict high-grade and any grade complications, respectively. Positive lymph node and pT≥3 were main factors affecting OS, RFS, and CSS. ASA score (p=0.048) and CCI (p=0.003) could predict OS and RFS, respectively. Elderly group had worse OS (p=0.007) and CSS (p=0.027) but similar RFS (p=0.147) compared with younger group. CONCLUSION: The elderly who received RARC had similar risk of perioperative complications and RFS compared with younger patients. RARC could be an alternative treatment for selected octogenarians.
BACKGROUND: Radical cystectomy (RC) is the standard treatment for bladder cancer, but the safety and efficacy of this treatment for elderly people need to be considered. We compare perioperative data and survival outcomes between elderly (≥80 years) and younger (<80 years) patients undergoing robot-assisted radical cystectomy (RARC). METHODS: We reviewed demographic, perioperative clinical and follow-up data of 190 consecutive patients with urothelial carcinoma of bladder who received RARC from May 2015 to December 2018 in Nanjing Drum Tower Hospital. The patients were divided into 2 groups by age: ≥80 years and <80 years. Perioperative outcomes were compared between 2 groups. Logistic regression method was used to analyze the factors that may affect preoperative complications. Cox regression model was employed to analyze the factors affecting 3-year overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS). RESULTS: Of the 190 patients, 44 (23.2%) were octogenarians. The elderly patients did not statistically differ from younger patients in most of the demographic, perioperative, and pathological information. American Society of Anesthesiologists (ASA) score (p=0.045) and Charlson comorbidity index (CCI) (p=0.035) could predict high-grade and any grade complications, respectively. Positive lymph node and pT≥3 were main factors affecting OS, RFS, and CSS. ASA score (p=0.048) and CCI (p=0.003) could predict OS and RFS, respectively. Elderly group had worse OS (p=0.007) and CSS (p=0.027) but similar RFS (p=0.147) compared with younger group. CONCLUSION: The elderly who received RARC had similar risk of perioperative complications and RFS compared with younger patients. RARC could be an alternative treatment for selected octogenarians.
Authors: Thomas W Flaig; Philippe E Spiess; Neeraj Agarwal; Rick Bangs; Stephen A Boorjian; Mark K Buyyounouski; Sam Chang; Tracy M Downs; Jason A Efstathiou; Terence Friedlander; Richard E Greenberg; Khurshid A Guru; Thomas Guzzo; Harry W Herr; Jean Hoffman-Censits; Christopher Hoimes; Brant A Inman; Masahito Jimbo; A Karim Kader; Subodh M Lele; Jeff Michalski; Jeffrey S Montgomery; Lakshminarayanan Nandagopal; Lance C Pagliaro; Sumanta K Pal; Anthony Patterson; Elizabeth R Plimack; Kamal S Pohar; Mark A Preston; Wade J Sexton; Arlene O Siefker-Radtke; Jonathan Tward; Jonathan L Wright; Lisa A Gurski; Alyse Johnson-Chilla Journal: J Natl Compr Canc Netw Date: 2020-03 Impact factor: 11.908
Authors: Bernard H Bochner; Guido Dalbagni; Karim H Marzouk; Daniel D Sjoberg; Justin Lee; Sheri M Donat; Jonathan A Coleman; Andrew Vickers; Harry W Herr; Vincent P Laudone Journal: Eur Urol Date: 2018-05-18 Impact factor: 20.096
Authors: Bernard H Bochner; Guido Dalbagni; Daniel D Sjoberg; Jonathan Silberstein; Gal E Keren Paz; S Machele Donat; Jonathan A Coleman; Sheila Mathew; Andrew Vickers; Geoffrey C Schnorr; Michael A Feuerstein; Bruce Rapkin; Raul O Parra; Harry W Herr; Vincent P Laudone Journal: Eur Urol Date: 2014-12-08 Impact factor: 20.096