Oncological outcomes of high-grade T1 non-muscle-invasive bladder cancer treatment in octogenarians

Aleksander Ślusarczyk,Piotr Zapała,Piotr Radziszewski,Karolina Garbas,Łukasz Zapała

doi:10.1007/s11255-021-02870-2

Abstract

PurposeTo evaluate the outcomes of high-grade T1 non-muscle-invasive bladder cancer treatment (NMIBC) in elderly patients over 80 years of age.MethodsThis is a retrospective single tertiary-centre study. Medical records of patients with T1 high-grade NMIBC treated with transurethral resection of the bladder tumour (TURBT) were reviewed. Among 269 patients with high-grade T1 NMIBC, 74 individuals were over 80 years of age at the time of surgery. Finally, 67 patients met the inclusion criteria.ResultsOnly 47.8% of patients (N = 32) received at least five of the six instillations of the BCG immunotherapy induction course. Oncological outcomes were compared between patients who received at least the induction course of BCG and non-BCG-treated patients matched to each other based on age and Charlson comorbidity index. Thirty case–control pairs were included in the final analysis. Rates of disease recurrence (80% vs. 53%) and cancer-specific mortality (40% vs. 10%) were significantly higher in the group of patients who did not receive BCG. BCG therapy, Charlson comorbidity index, haemoglobin concentration and the number of tumours > 3 in TURBT constituted independent prognostic factors for cancer-specific survival (CSS).ConclusionBCG should be strongly recommended to patients with T1HG NMIBC despite advanced age and comorbidities. Already BCG induction improves CSS and reduces the recurrence rate in octogenarians with T1HG bladder cancer.

Highlights

Bladder cancer is the eleventh most common malignancy worldwide [1]
Most patients present with nonmuscle-invasive bladder cancer (NMIBC) regarded as tumour confined to the mucosa (Ta or carcinoma in situ) or the submucous layer of the urinary bladder wall (T1), which might be effectively managed with transurethral resection of the bladder tumour (TURBT) [1]
We aimed to evaluate the results of T1HG bladder cancer treatment in patients over 80 years of age and assess the impact of intravesical Bacillus Calmette–Guerin (BCG) therapy on oncological outcomes

Summary

Introduction

Bladder cancer is the eleventh most common malignancy worldwide [1]. In general, most patients present with nonmuscle-invasive bladder cancer (NMIBC) regarded as tumour confined to the mucosa (Ta or carcinoma in situ) or the submucous layer of the urinary bladder wall (T1), which might be effectively managed with transurethral resection of the bladder tumour (TURBT) [1]. In NMIBC characterized as high-risk of progression (high-grade tumour, T1 category tumour or CIS), adjuvant treatment with intravesical Bacillus Calmette–Guerin (BCG) vaccine instillations is necessary to improve recurrence- (RFS) and progressionfree survival (PFS) [2, 3]. The prevalence of bladder cancer is highest in an elderly population, with 73 years being an average age of diagnosis and peak incidence reported at 85 years old [7, 8]. BC patients over 80 years of age often present with several comorbidities, with cardiovascular diseases being the most frequent. Patients require more individualized strategies to prevent disease progression without causing serious treatment complications and compromising their quality of life. Comorbidities and disability, these patients are not always fitting or eager to obtain optimal recommended oncological treatment

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