Bladder Preservation in Octogenarians With Invasive Bladder Cancer

Objectives

To analyze mortality and morbidity of octogenarians with newly diagnosed invasive transitional cell cancer (TCC) of the bladder who were managed without cystectomy.

Methods

Retrospective chart review of all patients with newly diagnosed invasive TCC (≥pT1) in the period of 1997-2007, who were 80 years or older at diagnosis.

Results

A total of 71 patients (86 + 4 years, mean + standard deviation [SD], pT1: n = 29; >pT2: n = 42) entered this analysis. In this geriatric population, treatment regimens were highly individualized. After transurethral resection, 61% of pT1-patients received bacillus Calmette-Guerin and 62% of those with >pT2-tumors external beam radiation. Mean overall survival (OS) of the entire cohort (n = 71) was 22 + 26 months for pT1-patients 34 + 33 versus 14 + 15 months for those with ≥pT2-tumors (P = .001). Mean cancer-specific survival was 58 months for pT1-patients and 11 months for ≥pT2-patients (P <.001). OS was correlated to tumor stage and the degree of mobility, to a lesser extent to the American Society of Anesthesiologists (ASA) score, and only marginally to chronologic age. Satisfactorily bladder function was preserved in 73%. pT1-patients spent 16% of their remaining life-span in the hospital compared with 23% for patients with >pT2-tumors.

Conclusions

OS in TCC is dependent on tumor stage, age, mobility, and comorbidities, and a risk-stratified management is necessary. Patients with pT1G3 tumor and low ASA score have satisfying OS with bladder preservation, but in patients with ≥pT2 and ASA 3-4 the prognosis is very bad. It remains questionable whether patients with tumor stages ≥pT2 and ASA 1-2 despite high age would benefit from radical cystectomy.