Utilization and Outcomes of Radical Cystectomy for High-grade Non-muscle-invasive Bladder Cancer in Elderly Patients

William P. Parker, Woodson Smelser, Eugene K. Lee, Elizabeth B Habermann, Prabin Thapa, Harras B. Zaid, Igor Frank, Tomas L. Griebling, Matthew K. Tollefson, R. Houston Thompson, Jeffrey M. Holzbeierlein, Robert Jeffrey Karnes, Stephen A. Boorjian

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Radical cystectomy (RC) represents a treatment option for patients with high-grade non-muscle-invasive bladder cancer (HG-NMIBC); however, perioperative morbidity is not insignificant, particularly in elderly patients. We sought to evaluate the associations of age with utilization and outcomes of RC for HG-NMIBC. Patients and Methods: Patients with HG-NMIBC diagnosed between 2004 and 2013 were identified in the National Cancer Database and stratified by age: ≤ 60, 61-70, 71-80, and > 80 years. Association between age and treatment with RC was assessed by multivariable logistic regression. Associations between age and overall survival were assessed using the Kaplan-Meier method. A multi-institutional analysis was performed to evaluate the associations of age with perioperative outcomes and survival among patients managed with RC for HG-NMIBC. Results: On multivariable analysis, age was associated with RC utilization, with the lowest usage in patients > 80 years (2.1%; P < .01). Upstaging at RC occurred in 40% of patients with HG-NMIBC, and no association of age with upstaging risk was noted. Significantly inferior overall survival was observed in the patients who were upstaged across age strata (all P < .01). In the multi-institutional cohort, age was not associated with risks of upstaging, receipt of transfusion, 30-/90-day complications, or recurrence-free or cancer-specific survival (all P > .05), whereas upstaging was associated with inferior recurrence-free and cancer-specific survival regardless of age. Conclusion: RC for HG-NMIBC is used less frequently in older adults, despite similar risks of pathologic upstaging. As upstaging is associated with inferior survival regardless of age, these data suggest that elderly patients with HG-NMIBC may be at risk for undertreatment.

Original languageEnglish (US)
JournalClinical Genitourinary Cancer
DOIs
StateAccepted/In press - 2017

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Cystectomy
Urinary Bladder Neoplasms
Survival
Neoplasms
Logistic Models
Databases
Morbidity
Recurrence
Therapeutics

Keywords

  • Complications
  • Outcomes
  • Practice patterns
  • Upstaging
  • Utilization

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Utilization and Outcomes of Radical Cystectomy for High-grade Non-muscle-invasive Bladder Cancer in Elderly Patients. / Parker, William P.; Smelser, Woodson; Lee, Eugene K.; Habermann, Elizabeth B; Thapa, Prabin; Zaid, Harras B.; Frank, Igor; Griebling, Tomas L.; Tollefson, Matthew K.; Thompson, R. Houston; Holzbeierlein, Jeffrey M.; Karnes, Robert Jeffrey; Boorjian, Stephen A.

In: Clinical Genitourinary Cancer, 2017.

Research output: Contribution to journalArticle

Parker, WP, Smelser, W, Lee, EK, Habermann, EB, Thapa, P, Zaid, HB, Frank, I, Griebling, TL, Tollefson, MK, Thompson, RH, Holzbeierlein, JM, Karnes, RJ & Boorjian, SA 2017, 'Utilization and Outcomes of Radical Cystectomy for High-grade Non-muscle-invasive Bladder Cancer in Elderly Patients', Clinical Genitourinary Cancer. https://doi.org/10.1016/j.clgc.2017.07.011
Parker, William P. ; Smelser, Woodson ; Lee, Eugene K. ; Habermann, Elizabeth B ; Thapa, Prabin ; Zaid, Harras B. ; Frank, Igor ; Griebling, Tomas L. ; Tollefson, Matthew K. ; Thompson, R. Houston ; Holzbeierlein, Jeffrey M. ; Karnes, Robert Jeffrey ; Boorjian, Stephen A. / Utilization and Outcomes of Radical Cystectomy for High-grade Non-muscle-invasive Bladder Cancer in Elderly Patients. In: Clinical Genitourinary Cancer. 2017.
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abstract = "Background: Radical cystectomy (RC) represents a treatment option for patients with high-grade non-muscle-invasive bladder cancer (HG-NMIBC); however, perioperative morbidity is not insignificant, particularly in elderly patients. We sought to evaluate the associations of age with utilization and outcomes of RC for HG-NMIBC. Patients and Methods: Patients with HG-NMIBC diagnosed between 2004 and 2013 were identified in the National Cancer Database and stratified by age: ≤ 60, 61-70, 71-80, and > 80 years. Association between age and treatment with RC was assessed by multivariable logistic regression. Associations between age and overall survival were assessed using the Kaplan-Meier method. A multi-institutional analysis was performed to evaluate the associations of age with perioperative outcomes and survival among patients managed with RC for HG-NMIBC. Results: On multivariable analysis, age was associated with RC utilization, with the lowest usage in patients > 80 years (2.1{\%}; P < .01). Upstaging at RC occurred in 40{\%} of patients with HG-NMIBC, and no association of age with upstaging risk was noted. Significantly inferior overall survival was observed in the patients who were upstaged across age strata (all P < .01). In the multi-institutional cohort, age was not associated with risks of upstaging, receipt of transfusion, 30-/90-day complications, or recurrence-free or cancer-specific survival (all P > .05), whereas upstaging was associated with inferior recurrence-free and cancer-specific survival regardless of age. Conclusion: RC for HG-NMIBC is used less frequently in older adults, despite similar risks of pathologic upstaging. As upstaging is associated with inferior survival regardless of age, these data suggest that elderly patients with HG-NMIBC may be at risk for undertreatment.",
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author = "Parker, {William P.} and Woodson Smelser and Lee, {Eugene K.} and Habermann, {Elizabeth B} and Prabin Thapa and Zaid, {Harras B.} and Igor Frank and Griebling, {Tomas L.} and Tollefson, {Matthew K.} and Thompson, {R. Houston} and Holzbeierlein, {Jeffrey M.} and Karnes, {Robert Jeffrey} and Boorjian, {Stephen A.}",
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T1 - Utilization and Outcomes of Radical Cystectomy for High-grade Non-muscle-invasive Bladder Cancer in Elderly Patients

AU - Parker, William P.

AU - Smelser, Woodson

AU - Lee, Eugene K.

AU - Habermann, Elizabeth B

AU - Thapa, Prabin

AU - Zaid, Harras B.

AU - Frank, Igor

AU - Griebling, Tomas L.

AU - Tollefson, Matthew K.

AU - Thompson, R. Houston

AU - Holzbeierlein, Jeffrey M.

AU - Karnes, Robert Jeffrey

AU - Boorjian, Stephen A.

PY - 2017

Y1 - 2017

N2 - Background: Radical cystectomy (RC) represents a treatment option for patients with high-grade non-muscle-invasive bladder cancer (HG-NMIBC); however, perioperative morbidity is not insignificant, particularly in elderly patients. We sought to evaluate the associations of age with utilization and outcomes of RC for HG-NMIBC. Patients and Methods: Patients with HG-NMIBC diagnosed between 2004 and 2013 were identified in the National Cancer Database and stratified by age: ≤ 60, 61-70, 71-80, and > 80 years. Association between age and treatment with RC was assessed by multivariable logistic regression. Associations between age and overall survival were assessed using the Kaplan-Meier method. A multi-institutional analysis was performed to evaluate the associations of age with perioperative outcomes and survival among patients managed with RC for HG-NMIBC. Results: On multivariable analysis, age was associated with RC utilization, with the lowest usage in patients > 80 years (2.1%; P < .01). Upstaging at RC occurred in 40% of patients with HG-NMIBC, and no association of age with upstaging risk was noted. Significantly inferior overall survival was observed in the patients who were upstaged across age strata (all P < .01). In the multi-institutional cohort, age was not associated with risks of upstaging, receipt of transfusion, 30-/90-day complications, or recurrence-free or cancer-specific survival (all P > .05), whereas upstaging was associated with inferior recurrence-free and cancer-specific survival regardless of age. Conclusion: RC for HG-NMIBC is used less frequently in older adults, despite similar risks of pathologic upstaging. As upstaging is associated with inferior survival regardless of age, these data suggest that elderly patients with HG-NMIBC may be at risk for undertreatment.

AB - Background: Radical cystectomy (RC) represents a treatment option for patients with high-grade non-muscle-invasive bladder cancer (HG-NMIBC); however, perioperative morbidity is not insignificant, particularly in elderly patients. We sought to evaluate the associations of age with utilization and outcomes of RC for HG-NMIBC. Patients and Methods: Patients with HG-NMIBC diagnosed between 2004 and 2013 were identified in the National Cancer Database and stratified by age: ≤ 60, 61-70, 71-80, and > 80 years. Association between age and treatment with RC was assessed by multivariable logistic regression. Associations between age and overall survival were assessed using the Kaplan-Meier method. A multi-institutional analysis was performed to evaluate the associations of age with perioperative outcomes and survival among patients managed with RC for HG-NMIBC. Results: On multivariable analysis, age was associated with RC utilization, with the lowest usage in patients > 80 years (2.1%; P < .01). Upstaging at RC occurred in 40% of patients with HG-NMIBC, and no association of age with upstaging risk was noted. Significantly inferior overall survival was observed in the patients who were upstaged across age strata (all P < .01). In the multi-institutional cohort, age was not associated with risks of upstaging, receipt of transfusion, 30-/90-day complications, or recurrence-free or cancer-specific survival (all P > .05), whereas upstaging was associated with inferior recurrence-free and cancer-specific survival regardless of age. Conclusion: RC for HG-NMIBC is used less frequently in older adults, despite similar risks of pathologic upstaging. As upstaging is associated with inferior survival regardless of age, these data suggest that elderly patients with HG-NMIBC may be at risk for undertreatment.

KW - Complications

KW - Outcomes

KW - Practice patterns

KW - Upstaging

KW - Utilization

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