Bladder cancer is one of the most common diseases in the elderly. Radical cystectomy combined with local lymph node dissection and urinary diversion is the standard treatment for invasive bladder cancer. However, the frailty of the elderly and the presence of underlying disease in most cases make these treatments less effective.
In a recent article in Urology, Michael et al. from Queen’s University, Canada, retrospectively analyzed the prognosis of elderly bladder cancer patients undergoing radical surgery and evaluated the use of adjuvant chemotherapy (ACT) in patients with invasive bladder cancer. The results suggest that elderly bladder cancer patients are at high risk of postoperative death; although adjuvant chemotherapy is beneficial to patient survival, it is not commonly used in elderly bladder cancer patients.
The study included 3320 patients with bladder cancer who underwent radical cystectomy in the Ontario Cancer Registry from 1994 to 2008. The efficacy of adjuvant chemotherapy application was assessed by analyzing pathology reports and treatment courses of these patients.
The subjects were divided into four groups according to age: 1362 patients (41%) younger than 70 years, 674 patients (20%) aged 70-74 years, 674 patients (19%) aged 75-79 years, and 657 patients (20%) aged ≥80 years. All mortality rates increased with age.
The 5-year tumor-specific survival rates for these four groups were 40%, 34%, 28%, and 23%, respectively, and the use of adjuvant chemotherapy decreased with increasing age. Among patients treated with adjuvant chemotherapy, a higher proportion of patients younger than 70 years of age received cisplatin than patients older than 70 years of age (87% : 73%). Overall, adjuvant chemotherapy was associated with improved tumor-specific survival and overall survival.
This study responds to the clinical outcomes after radical resection and the use of adjuvant chemotherapy in elderly bladder cancer patients. Survival of older bladder cancer patients in the general population was significantly worse than that reported by the center.
Compared to younger patients, older patients had higher tumor pathologic grade, pelvic lymph node dissection was not easily performed, and adjuvant chemotherapy was used less frequently. The lower proportion of adjuvant chemotherapy application in elderly patients may be related to severe complications and renal impairment. Further efforts are needed to improve the survival of elderly patients with bladder cancer.