OCTOGENARIANS CAN GET RADICAL CYSTECTOMY

NEW YORK (Reuters Health) May 05 - Radical cystectomy in older patients with muscle invasive bladder cancer yields disease control and survival outcomes similar to those in younger patients, according to a study in the June issue of the Journal of Urology.

In community settings, this procedure "continues to be underused" in elderly patients, say Dr. S. Machele Donat and colleagues from Memorial Sloan-Kettering Cancer Center, New York.

In a retrospective study, the researchers analyzed morbidity and survival in 1142 patients who had radical cystectomy at their center between 1995 and 2005, including 117 who were at least 80 years old.

Eleven percent of octogenarians had an intensive care unit admission, compared to 4% of younger patients (p = 0.006). No significant differences were observed between the groups in patients needing a postoperative angio-interventional program, return to the operating room, or secondary surgical procedures during hospitalization or within 90 days of discharge.

The older patients had nonsignificantly higher rates of minor (55% vs 51%) and major (17% vs 13%) complications within 90 days of surgery.

The risk for major complications increased slightly up to age 65 years, and then flattened (p = 0.16).

After adjusting for preoperative characteristics, there was a small, nonsignificant increase in the risk of any complication by age. The authors note that the risk for any complication was "roughly flat" across all ages.

The 90-day mortality rate was 2.7% overall, 6.8% in the octogenarians (8 of 117), and 2.2% in the younger patients (23 of 1025; p = 0.01).

At last follow-up, 59 octogenarians and 340 younger patients had died. The median times to death in the groups were 3.3 and 7.9 years, respectively. The cumulative incidence of death from bladder cancer was similar for octogenarians and younger patients (5-year cumulative incidence 25.7% and 24.6%, respectively) after adjusting for deaths from other causes.

"The benefits of local disease control conferred with radical cystectomy must be weighed against the potential 90-day perioperative mortality (6.8%) in patients 80 years or older and may be used in counseling patients preoperatively," the researchers conclude.