Impact of age >70 years on oncological outcomes in patients with non‐muscle‐invasive bladder cancer treated with Bacillus Calmette–Guérin

Abstract

ObjectiveTo evaluate the impact of age on oncological outcomes in a large contemporary cohort of patients with non‐muscle‐invasive bladder cancer (NMIBC) treated with adequate Bacillus Calmette–Guérin (BCG).Patients and MethodsWe performed an Institutional Review Board‐approved retrospective study analysing patients with NMIBC treated with adequate BCG at our institution from 2000 to 2020. Adequate BCG was defined as per United States Food and Drug Administration (FDA) guidelines as being receipt of at least five of six induction BCG instillations with a minimum of two additional doses (of planned maintenance or of re‐induction) of BCG instillations within a span of 6 months. The study's primary outcome was to determine if age >70 years was associated with progression to MIBC cancer or distant metastasis. The cumulative incidence method and the competing‐risk regression analyses were used to investigate the association of advanced age (>70 years) with progression, high‐grade (HG) recurrence and cancer‐specific mortality (CSM).ResultsOverall, data from 632 patients were analysed: 355 patients (56.2%) were aged ≤70 years and 277 (43.8%) were >70 years. Age >70 years did not adversely affect either cumulative incidence of progression or HG recurrence (P = 0.067 and P = 0.644, respectively). On competing‐risk regression analyses, age >70 years did not emerge as an independent predictor of progression or HG recurrence (sub‐standardised hazard ratio [SHR] 1.57, 95% confidence interval [CI] 0.87–2.81, P = 0.134; and SHR 1.05, 95% CI 0.77–1.44, P = 0.749). Not unexpectedly, patients in the older group did have higher overall mortality (P < 0.001) but not CSM (P = 0.057).ConclusionAge >70 years was not associated with adverse oncological outcomes in a large contemporary cohort of patients receiving adequate intravesical BCG for NMIBC. BCG should not be withheld from older patients seeking for bladder sparing options.

Influence of lamina propria invasion extension on T1 high‐grade non‐muscle‐invasive bladder cancer in patients undergoing BCG or radical cystectomy

“…The current EAU risk classification systems incorporate some parameters that are controversial such as tumour size, whose estimation is often inaccurate, and age >70 years [5,18]. We also observed a significant association between E/M infiltration of the LP and the presence of histological subtypes and LVI.…”

The Urinary Microbiome in Health and Disease: Relevance for Bladder Cancer

“…Notably, recently, it has been found that, in a cohort of patients with NMIBC treated with adequate BCG, age >70 years was not a predictor of poor outcomes or associated with adverse oncological events. BCG should not be withheld from older patients seeking bladder-sparing options [171]. In addition to triggering innate and adaptive immunity, BCG exerts direct cytotoxic effects on BC cells, activating apoptosis through the caspase 8, caspase 9, and proapoptotic protein BID signaling pathway [172,173].…”

Charlson–Deyo Comorbidity Index as a Novel Predictor for Recurrence in Non-Muscle-Invasive Bladder Cancer

“…Tumor characteristics (at first TURB) consisted of stage (pTa low-grade (LG) vs. pTa high-grade (HG) vs. pT1 vs. pTis), EAU risk groups (version 2020; low vs. intermediate vs. high vs. very high) [16], concomitant carcinoma in situ (CIS), presence of the detrusor muscle in histology, and adjuvant therapy (either immediate postoperative intravesical chemotherapy or Bacillus Calmette-Guérin (BCG)). The covariates were chosen based on their recognized associations with the outcomes of NMIBC patients [16,[18][19][20][21][22]. The endpoint of the study was a recurrence of primary NMIBC.…”