Evaluation of cause of death after radical cystectomy for patients with bladder cancer: the impact of age at the time of surgery

Abstract

The median age at diagnosis for patients with bladder cancer is 70 years, and therefore patients who have undergone a radical cystectomy represent a heterogeneous group with respect to cancer-specific mortality (CSM) and other cause mortality. Our results showed that the risk of CSM decreased in favor of other cause mortality with the increasing of age and decreasing of stage. However, CSM is the preponderant cause of death for all of the evaluated subgroup. In this regard, radical cystectomy also seems to be a reasonable approach for octogenarians.Introduction: Patients with bladder cancer treated with radical cystectomy (RC) have heterogeneous results in term of cancer-specific (CSM) and other cause mortality (OCM). Our aim is to assess the impact of age on cause of death after RC. Patients and Methods: We retrospectively analyzed the data of 1222 patients treated with RC and bilateral pelvic lymph node dissection owing to nonmetastatic bladder cancer between 1990 and 2013. Patients were stratified according to age (< 59 vs. 60-69 vs. 70-79 vs. > 80 years), tumor T stage at RC (pT0-T2 vs. pT3-T4), and tumor N stage at RC (pN vs. pN0). Competing-risks survival analyses were used to estimate CSM and OCM rates. Results: With a median follow up of 6 years, 92 (7.5%) and 385 (31.5%) OCM and CSM were recorded. The 5-year CSM and OCM rates were 40% and 8.8%, respectively. After stratification according to disease stage and patient age, CSM emerged as the main cause of mortality in all patient subgroups. The 5-year OCM was 4.6%, 4.8%, 11%, and 32% for patients aged < 60 years versus 60 to 69 years versus 70 to 79 years versus > 80 years, respectively. The 5-years CSM was 34%, 45%, 35%, and 56% for patients aged < 60 years versus 60 to 69 years versus 70 to 79 years versus > 80 years, respectively. Similar findings were observed stratifying the population according to pathologic T and N stage. Conclusion: CSM is the preponderant cause of death for all the patients, regardless of age or stage. In this regard, RC also seems to be a reasonable approach for octogenarians. (C) 2019 Elsevier Inc. All rights reserved.