Significance of age and comorbidity as prognostic indicators for patients with bladder cancer

Abstract

The aim of this study was to determine the impact that age and comorbidity status have on both overall and bladder cancer-specific survival of bladder cancer patients. We obtained medical information pertaining to a population of 528 patients with newly diagnosed bladder cancer from Chung-Ang University Hospital cancer registry. The Adult Comorbidity Evaluation-27 (ACE-27) test, which has been previously validated in adult cancer patients, was used to assess comorbidity. We evaluated differences in the demographic and clinical characteristics of included patients, as well as differences in the treatments they received after categorizing them by age. The median age at the time of bladder cancer diagnosis of the entire cohort was 63 years, and the median follow-up time was 97 months. Of the 528 patients who were included in our study, 303 had at least one comorbid condition and 249 died during the follow-up period. When patients were stratified by age, we found that older patients had a higher proportion of severe comorbidities (P < 0.01) than younger patients, and that a lower proportion of them underwent radical cystectomy for invasive bladder cancer (IBC) (P < 0.01). By multivariate analysis, we found that older age was predictive of lower overall survival (OS) and bladder cancer-specific survival (BCSS) rates among patients with superficial bladder cancer (SBC) and of lower OS rates among patients with IBC. We also found that moderate-severe comorbidity status and treatment through a bladder-conserving approach were predictive of lower OS and cancer-specific survival rates among patients with IBC. The disparity between overall deaths and bladder cancer deaths was shown in SBC and increased along with age and higher comorbidity. Age and comorbidity were found to be independent predictive factors of OS and BCSS among bladder cancer patients, and explained the disparity that we observed between overall bladder cancer-specific mortality rates.

Treatment of bladder cancer in the elderly

“…This population has been associated with many comorbidities and a shorter life expectancy [ 2 10 ]. Comorbiditity and age have been found to be independent predictors of overall survival (OS) in BC patients [ 12 13 14 ].…”

“…When selecting patients to undergo RadC, the institution and urologist (training and experience) are important in the outcome of the procedure [ 21 ]. Elderly patients undergo RadC for MIBC less often than younger patients [ 9 13 22 23 ]. Specifically using the SEER-Medicare data, two separate studies showed that older patients (age >80 [ 24 ], >75 [ 25 ]) are less likely treated with RadC.…”

“…Interesting to note, in one study, age was a factor for OS (p=0.0001) in BC patients however, in a subgroup of those patients treated by cystectomy, age was not significant upon multivariate analysis (hazard ratio, 1.19; 95% confidence interval, 0.92–1.54; p=0.1810) [ 12 ]. Another study found that older patients had a lower OS possibly brought on by a higher proportion of severe comorbidities (p<0.01) compared to younger BC patients [ 13 ].…”

Does patient age affect survival after radical cystectomy?

“…Thus, while advances in medicine have increased the mean lifespan of the population, it has also generated a society of elderly patients affected by this disease and likely to seek treatment. Older patients have more years to compound comorbidities and it has previously been shown that comorbidity is an important predictor of overall survival (OAS) in patients with BC, including those treated with cystectomy [4–6]. Other studies have also shown a higher stage at diagnosis, higher rate of upstaging on final pathology and a longer delay to definitive therapy for older patients [7–10].…”

Upregulation of cell adhesion through delta Np63 silencing in human 5637 bladder cancer cells

“…When F-actin expression is increased, F-actin aligns with the cell's polarity, which results in reduced tumour metastasis. [34][35][36] Increases in the density of F-actin result in loose arrangements that are not aligned with cell polarity and result in increased tumour metastasis. Therefore, delta Np63 may be a new drug target for TCCB therapy, especially in efforts to target invasion and metastasis.…”