Does patient age affect survival after radical cystectomy?

Abstract

OBJECTIVE: • To analyse the impact of patient age on survival after radical cystectomy (RC). PATIENTS AND METHODS: • After ethics review board approval, two databases of patients with bladder cancer (BC) undergoing RC at the University Heath Network, Toronto, Canada (1992 - 2008) and the University of Turku, Turku, Finland (1986 - 2005) were retrospectively analysed. • A total of 605 patients who underwent this procedure between June 1985 and March 2010 were included. • Patients were divided into four age groups: ≤ 59, 60 - 69, 70 - 79 and ≥ 80 years. • Demographic, clinical and pathological data were compared, as well as recurrencefree survival (RFS), disease-specific survival (DSS) and overall survival (OAS) rates. RESULTS: • Compared with younger patients (age ≤ 79 years), elderly patients (age ≥ 80 years) had higher American Society of Anesthesiologists scores ( P < 0.001), a greater number of lymph nodes removed during surgical dissection ( P < 0.001), and underwent less adjuvant treatment ( P < 0.001). • Choice of urinary diversion differed among the groups, with ileal conduit being used for all patients ≥ 80 years ( P < 0.001). • No differences were noted between age groups with respect to RFS ( P = 0.3), DSS ( P = 0.4) or OAS ( P = 0.4). CONCLUSION: • Although RC is an operation with significant morbidity, it is a viable treatment option for carefully selected elderly patients. Senior patients ( ≥ 80 years) should not be denied RC if they are deemed fit to undergo surgery. • Senior adults do not suffer from adverse histopathological features as compared with younger patients. © 2012 BJU International.