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 recurrence-free 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.