Matteo Ferro1, Sever Chiujdea2, Gennaro Musi3, Giuseppe Lucarelli4, Francesco Del Giudice5, Rodolfo Hurle6, Rocco Damiano7, Francesco Cantiello7, Andrea Mari8, Andrea Minervini8, Gian Maria Busetto9, Giuseppe Carrieri9, Felice Crocetto10, Biagio Barone10, Vincenzo Francesco Caputo10, Luigi Cormio11, Pasquale Ditonno12, Alessandro Sciarra5, Daniela Terracciano13, Antonio Cioffi14, Stefano Luzzago14, Mattia Piccinelli14, Francesco Alessandro Mistretta14, Mihai Dorin Vartolomei15, Ottavio de Cobelli3. 1. Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy. Electronic address: matteo.ferro@ieo.it. 2. IOSUD, Universitatea de Medicină Farmacie, Știinte și Tehnologie "George Emil Palade" din Târgu Mureș, Mureș, Romania. 3. Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy; Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy. 4. Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Italy. 5. Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy. 6. IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. 7. Department of Urology, University of Catanzaro, UNIVERSITÁ "MAGNA GRÆCIA" di Catanzaro, Catanzaro, Italy. 8. Unit of Oncologic Minimally- Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy. 9. Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy. 10. Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy. 11. Department of Urology and Renal Transplantation, University of Foggia-Ospedali Riuniti of Foggia, Foggia, Italy; Department of Urology, Bonomo Teaching Hospital, Andria (BAT), Italy. 12. Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy. 13. Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy. 14. Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy. 15. Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy; IOSUD, Universitatea de Medicină Farmacie, Știinte și Tehnologie "George Emil Palade" din Târgu Mureș, Mureș, Romania; Urology Department, Medical University of Vienna, Vienna, Austria.
Abstract
INTRODUCTION: The aim of this multicenter study was to investigate the role of age (cut-off 70 years) at diagnosis in predicting oncologic behavior of pure carcinoma in situ of the bladder. MATERIAL AND METHODS: Inclusion criteria were: patients with pure CIS confirmed and that followed intravesical BCG treatment. Pure CIS was defined at any CIS not associated with another urothelial cancer. Exclusion criteria were: any CIS associated with invasive urothelial carcinoma. A total of 172 with pure CIS treated between January 1, 2002 and December 31, 2012 at 8 academic institutions met the inclusion criteria. The maintenance schedule was generally according to the EAU guidelines at the time RESULTS: A total of 99 (57.6%) patients had an age >70 years prior to TURBT. There was no difference between clinico-pathologic features among groups (group 1, age ≤ 70 years and group 2, age > 70 years), except that patients aged ≤ 70 years presented a larger size of CIS (35.6% vs. 21.2%), P = .02. In multivariable Cox regression analyses, the same clinico-pathologic factors (age, multifocality, and recurrent tumor state) were independently associated with worse RFS. Harrell's C-index was 65.75.In multivariable Cox regression analyses in addition to age (P = .006) and multifocality (P < .001) also BMI (P = .04) was independently associated with worse PFS. Harrell's C-index was 74.71 CONCLUSION: Advanced age at diagnosis appears to be associated with an increased risk of recurrence and progression of pure carcinoma in situ of the bladder. Elderly patients might fail to respond to BCG therapy.
INTRODUCTION: The aim of this multicenter study was to investigate the role of age (cut-off 70 years) at diagnosis in predicting oncologic behavior of pure carcinoma in situ of the bladder. MATERIAL AND METHODS: Inclusion criteria were: patients with pure CIS confirmed and that followed intravesical BCG treatment. Pure CIS was defined at any CIS not associated with another urothelial cancer. Exclusion criteria were: any CIS associated with invasive urothelial carcinoma. A total of 172 with pure CIS treated between January 1, 2002 and December 31, 2012 at 8 academic institutions met the inclusion criteria. The maintenance schedule was generally according to the EAU guidelines at the time RESULTS: A total of 99 (57.6%) patients had an age >70 years prior to TURBT. There was no difference between clinico-pathologic features among groups (group 1, age ≤ 70 years and group 2, age > 70 years), except that patients aged ≤ 70 years presented a larger size of CIS (35.6% vs. 21.2%), P = .02. In multivariable Cox regression analyses, the same clinico-pathologic factors (age, multifocality, and recurrent tumor state) were independently associated with worse RFS. Harrell's C-index was 65.75.In multivariable Cox regression analyses in addition to age (P = .006) and multifocality (P < .001) also BMI (P = .04) was independently associated with worse PFS. Harrell's C-index was 74.71 CONCLUSION: Advanced age at diagnosis appears to be associated with an increased risk of recurrence and progression of pure carcinoma in situ of the bladder. Elderly patients might fail to respond to BCG therapy.