Functional outcomes of older adults treated with radical cystectomy for muscle-invasive bladder cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17010-e17010
Author(s):  
Chelsea K. Osterman ◽  
Allison Mary Deal ◽  
Kirsten A. Nyrop ◽  
Matthew I. Milowsky ◽  
Hyman B. Muss ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Functional Status ◽  
Physical Function ◽  
Older Patients ◽  
Social Activity ◽  
Time Frame ◽  
Muscle Invasive Bladder Cancer ◽  
Younger Patients ◽  
Significant Difference ◽  
Muscle Invasive

e17010 Background: Older patients with muscle-invasive bladder cancer (MIBC) may not be offered standard of care treatment with neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) based on their chronological age and concern for functional decline following therapy. Age-based differences in post-RC functional status or time to recovery are unknown. Methods: A total of 80 patients were included in this study. Patients ≥ 70 years were categorized as “older” and < 70 years as “younger.” To measure functional status, patients completed an initial geriatric assessment (GA) post-NAC and pre-RC, which was repeated at 1, 3, and 12 months post-RC. Results: Median age was 62 years for younger patients (41-69 years; n = 42) and 75 years for older patients (70-83 years; n = 38). Clinical stage at presentation was not different between groups, but older patients were significantly less likely to receive NAC (63% vs 83%, p = 0.047). There was no significant difference between groups in any physical function measure at baseline. At 1 month post-RC, older patients had significantly lower clinician (c) and patient (p) rated Karnofsky Performance Status (KPS) than younger patients (cKPS: 70 vs 80, p = 0.02; pKPS 60 vs 80, p = 0.03), with a significantly greater decrease from baseline (20 points vs 0 points) in both KPS scores compared to younger patients (cKPS p = 0.001; pKPS p = 0.005). Both groups had a significant decline in ability to complete instrumental activities of daily living (IADLs), but older patients also had significantly increased social activity limitations. At 3 months post-RC, older patients took significantly longer to complete the timed up and go test than younger patients (10.2 secs vs 9 secs, p = 0.02), but had no other differences in physical function measures. Older patients had no significant difference in any measure at 3 months post-RC compared to baseline, while younger patients had a significant improvement in social activity over this time frame. Conclusions: Older patients with MIBC experience a greater short-term decline in functional status post-RC compared to younger patients. However, they return to their baseline status within the same time frame as younger patients.

Treatment of Muscle-Invasive Bladder Cancer in Older Patients

2016 ◽  
pp. e228-e233
Author(s):  
Eila C. Skinner
Keyword(s):  
Bladder Cancer ◽  
Older Patients ◽  
Systemic Chemotherapy ◽  
Population Data ◽  
Invasive Bladder Cancer ◽  
Patient Treatment ◽  
Muscle Invasive Bladder Cancer ◽  
Definitive Therapy ◽  
Localized Disease ◽  
Muscle Invasive

Treatment of muscle-invasive bladder cancer in older patients is challenging. Definitive therapy of localized disease requires either surgery or radiation therapy, ideally combined with systemic chemotherapy. However, current population data suggest that less than half of patients older than age 70 are offered such treatments. We will review tools available to assess the fitness of older patients for surgery, alternatives, and tips for perioperative patient treatment.

The impact of histologic variants of urothelial carcinoma on clinical outcomes following trimodal bladder-preserving therapy.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 421-421
Author(s):  
Yoshiyuki Nagumo ◽  
Shuya Kandori ◽  
Tomokazu Kimura ◽  
Takashi Kawahara ◽  
Takahiro Kojima ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Clinical Outcomes ◽  
Invasive Bladder Cancer ◽  
Rank Test ◽  
Muscle Invasive Bladder Cancer ◽  
Bladder Preservation ◽  
Significant Difference ◽  
Muscle Invasive ◽  
The Impact

421 Background: The current guidelines for muscle-invasive bladder cancer recommend the use of neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy. However, a trimodal approach involving the combination of maximal transurethral resection (TUR) and combined chemoradiotherapy is an alternative in selected patients. Clinical outcomes of patients with histologic variants have not well been known. Methods: From 1990 to 2015, 148 patients with cT2-3N0M0 muscle-invasive bladder cancer underwent trimodal bladder-preserving therapy consisting of maximal TUR of the bladder tumor, intra-arterial chemotherapy and radiotherapy at our institution. We compared complete response rate (CRR) of bladder preservation, 5-yr cause-specific survival (CSS), and 5-yr overall survival (OS) for the patients with pure urothelial carcinoma (UC) or variant UC. OS and CSS were analyzed by using the Kaplan-Meier method and log-rank test. Results: The median follow-up was 38.3 months. All patients were T2-T3N0M0 (T2, n = 90; T3, n = 58). There were no significant differences in clinical characteristics between pure and variant UC groups. Eleven (7%) of the 148 patients had variant UC; 7 (64%) had UC with squamous and/or glandular differentiation, and 4 (36%) had other forms, including sarcomatoid (n = 1), plasmacytoid (n = 1), signet ring cell (n = 1), and clear cell variants (n = 1). There was no significant difference between pure UC and variant UC for CRR of bladder preservation (85% vs 82%, p = 0.66), the 5-yr CSS (88% vs 75%, p = 0.86) and the 5-yr OS (81% vs 75%, p = 0.66). Conclusions: Our findings indicate that trimodal bladder-preserving therapy can be an effective treatment option for selected muscle-invasive bladder cancer patients with variant UC.

scholarly journals The Effect of Tri-Modality Therapy with Bladder Preservation for Selective Muscle-Invasive Bladder Cancer

2021 ◽  
Vol 20 ◽  
pp. 153303382110623
Author(s):  
Zhang Zhiyu ◽  
Zhou Qi ◽  
Song Zhen ◽  
Ouyang Jun ◽  
Zhang Jianglei
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Linear Regression Analysis ◽  
Univariate Analysis ◽  
Tnm Staging ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Bladder Preservation ◽  
Significant Difference ◽  
Muscle Invasive

Objectives: To compare the efficacy of complete transurethral resection of bladder tumor combined with postoperative chemoradiotherapy and radical cystectomy (RC) in the treatment of muscle-invasive bladder cancer (MIBC). Methods: This is a single-center, retrospective study. Clinical data of 125 patients with MIBC admitted to the First Affiliated Hospital of Soochow University from December 2012 to December 2015 were retrospectively analyzed, in which 79 patients (tri-modality therapy [TMT] group) received TMT bladder-sparing treatment, and 41 patients (RC group) received RC. The differences of probabilities for 1-year, 2-year, 5-year, and comprehensive overall survival (OS), progress-free survival (PFS) between 2 groups were calculated using Kaplan–Meier product limited estimates. Univariate and multivariate analyses were performed to detect potential risk factors for OS and PFS. Results: There was no statistical difference between the TMT group and RC group in the 1-year, 2-year, 5-year, comprehensive OS rate, and PFS rate. And survival analysis found no significant difference in OS and PFS between the 2 groups. Univariate analysis showed that age, TNM staging, and prognostic nutritional index (PNI) were associated with OS, while PNI was connected to tumor recurrence. Multiple linear regression analysis indicated that TNM staging and PNI were independent risk factors for OS. Conclusions: TMT can be used as an alternative to RC for MIBC patients under the premise of strict control of indications, rigorous postoperative follow-up, and timely salvage cystectomy. PNI was negatively correlated with OS and PFS, while TNM staging was positively correlated with OS.

scholarly journals Complications and Discharge after Radical Cystectomy for Older Patients with Muscle-Invasive Bladder Cancer: The ELCAPA-27 Cohort Study

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 6010
Author(s):  
Romain Geiss ◽  
Lucrezia Sebaste ◽  
Rémi Valter ◽  
Johanne Poisson ◽  
Soraya Mebarki ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Geriatric Assessment ◽  
Complication Rate ◽  
Older Patients ◽  
Univariate Analysis ◽  
Invasive Bladder Cancer ◽  
High Morbidity ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

Radical cystectomy is the standard of care for localized bladder cancer but is associated with high morbidity and mortality rates—especially among older patients with comorbidities. The association between geriatric assessment parameters on post-operative complications and discharge has not previously been investigated. The present analysis of the Elderly Cancer Patient (ELCAPA) prospective cohort included all patients aged ≥70 having undergone a geriatric assessment and then radical cystectomy for localized muscle-invasive bladder cancer between 2007 and 2018. The primary endpoint was the proportion of patients with one or more complications in the first 30 days after cystectomy. The secondary endpoints were the length of hospital stay (LOS), the 30-day mortality, and discharge rates. Sixty-two patients (median age: 81; range: 79–83.8) were included. The 30-day complication rate was 73%, and 49% of the patients had experienced a major complication, according to the Clavien-Dindo classification. The 30-day mortality rate was 4%. None of the geriatric, oncological, or laboratory parameters were significantly associated with the occurrence or severity of complications. The median (interquartile range) LOS was 18 days (15–23) overall and was longer in patients with complications (19 days vs. 15 days in those without complications; p = 0.013). Thirty days after cystectomy, 25 patients (53%) had been discharged to home and 22 (47%) were still in a rehabilitation unit. In a univariate analysis, a Geriatric-8 score ≤14, a loss of one point on the Activities of Daily Living Scale, anemia, at least one grade ≥3 comorbidity on the Cumulative Illness Rating Scale-Geriatric, and an inpatient geriatric assessment were associated with a risk of not being discharged to home. In older patients having undergone a geriatric assessment, radical cystectomy is associated with a high complication rate, a longer LOS, and functional decline at 30 days.

scholarly journals 1470 nm/980 nm dual-wavelength laser is safe and efficient for the en-bloc resection of non-muscle invasive bladder cancer: A propensity score-matched analysis

2021 ◽  
Vol 49 (12) ◽  
pp. 030006052110653
Author(s):  
Jianhan Fu ◽  
Fajun Fu ◽  
Yinhuai Wang
Keyword(s):  
Bladder Cancer ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Dual Wavelength ◽  
Muscle Invasive Bladder Cancer ◽  
En Bloc ◽  
Dual Wavelength Laser ◽  
Significant Difference ◽  
Laser Group ◽  
Muscle Invasive

Objective To evaluate the efficacy and safety of a 1470 nm/980 nm dual-wavelength laser system used for the en-bloc resection of non-muscle invasive bladder cancer (NMIBC) compared with transurethral resection of bladder tumour (TURBT). Methods This retrospective study analysed the demographic and clinical data from patients diagnosed with NMIBC that were treated by either dual laser or TURBT. Intraoperative characteristics, postoperative characteristics and outcomes between the two groups were compared. Results This study analysed 64 patients, 32 in each group. No severe complications were identified in either group. After propensity score-matching, there were no significant differences between the two groups in terms of the demographics, clinical and tumour characteristics. There was no significant difference between the two groups in terms of specimen quality. In the laser group, intraoperative blood loss was significantly lower and significantly fewer patients required continuous bladder irrigation after surgery, compared with the TURBT group. No significant differences were observed in the catheterization time, gross haematuria time and hospitalization time. Operation time in the laser group was significantly longer compared with the TURBT group. No significant difference was found in the recurrence and progression rates between the two groups. Conclusions The 1470 nm/980 nm dual-wavelength laser provides a safe and effective surgical treatment option for patients with NMIBC.

International comparison of treatment and outcome in older patients with muscle-invasive bladder cancer.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e20517-e20517
Author(s):  
Martine Extermann ◽  
Katja Aben ◽  
Kathleen Egan ◽  
Anton J.M. de Craen ◽  
Cornelis J. H. Van De Velde ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
International Comparison ◽  
Older Patients ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

scholarly journals Identification and Immunocorrelation of Prognosis-Related Genes Associated With Development of Muscle-Invasive Bladder Cancer

2021 ◽  
Vol 7 ◽  
Author(s):  
Jingxian Li ◽  
Yantao Lou ◽  
Shuai Li ◽  
Fei Sheng ◽  
Shuaibing Liu ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Molecular Mechanisms ◽  
Low Risk ◽  
Enrichment Score ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Immune Infiltration ◽  
Stratification Method ◽  
Significant Difference ◽  
Muscle Invasive

Improved understanding of the molecular mechanisms and immunoregulation of muscle-invasive bladder cancer (MIBC) is essential to predict prognosis and develop new targets for therapies. In this study, we used the cancer genome atlas (TCGA) MIBC and GSE13507 datasets to explore the differential co-expression genes in MIBC comparing with adjacent non-carcinoma tissues. We firstly screened 106 signature genes by Weighted Gene Co-expression Network Analysis (WGCNA) and further identified 15 prognosis-related genes of MIBC using the univariate Cox progression analysis. Then we systematically analyzed the genetic alteration, molecular mechanism, and clinical relevance of these 15 genes. We found a different expression alteration of 15 genes in MIBC comparing with adjacent non-carcinoma tissues and normal tissues. Meanwhile, the biological functions and molecular mechanisms of them were also discrepant. Among these, we observed the ANLN was highly correlated with multiple cancer pathways, molecular function, and cell components, revealing ANLN may play a pivotal role in MIBC development. Next, we performed a consensus clustering of 15 prognosis-related genes; the results showed that the prognosis, immune infiltration status, stage, and grade of MIBC patients were significantly different in cluster1/2. We further identified eight-genes risk signatures using the least absolute shrinkage and selection operator (LASSO) regression analysis based on the expression values of 15 prognosis-related genes, and also found a significant difference in the prognosis, immune infiltration status, stage, grade, and age in high/low-risk cohort. Moreover, the expression of PD-1, PD-L1, and CTLA4 was significantly up-regulated in cluster1/high-risk-cohort than that in cluster2/low-risk-cohort. High normalized enrichment score of the Mitotic spindle, mTORC1, Complement, and Apical junction pathway suggested that they might be involved in the distinct tumor immune microenvironment (TIME) of cluster1/2 and high-/low-risk-cohort. Our study identified 15 prognosis-related genes of MIBC, provided a feasible stratification method to help for the future immunotherapy strategies of MIBC patients.

The challenges of Bacillus of Calmette-Guerin (BCG) therapy for high risk non muscle invasive bladder cancer treatment in older patients

2018 ◽  
Vol 9 (5) ◽  
pp. 507-512 ◽  
Author(s):  
Marco Racioppi ◽  
Luca Di Gianfrancesco ◽  
Mauro Ragonese ◽  
Giuseppe Palermo ◽  
Emilio Sacco ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Cancer Treatment ◽  
Older Patients ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Bcg Therapy ◽  
Muscle Invasive
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