Survival outcomes in elderly patients with muscle invasive bladder cancer: An analysis of the National Cancer Database.

Abstract

4538 Background: Many elderly patients are precluded from radical cystectomy (RC) due to existing comorbidities or morbidities associated with RC. Chemoradiation therapy (CRT) is an alternative treatment in this population, but remains widely under-utilized with many receiving chemotherapy (CT) or radiation therapy (RT) alone. This population-based analysis sought to determine if CMT has similar overall survival (OS) to RC, and if CRT is associated with improved OS compared to monotherapy in these patients. Methods: We queried the National Cancer Database (NCDB) for all newly diagnosed MIBC (cT2-T4a N0 M0) cases in patients aged 80 years or older from 2004 to 2013. All included patients underwent TURBT followed by RC, RT alone, CT alone, CRT, or no further treatment. Only patients with radiation doses ( > = 50Gy) were included as receiving RT. Kaplan-Meier, log-rank, and multivariate Cox proportional hazards regression was performed with OS as the primary outcome. Results: 10,055 patients aged > = 80 years were identified. 1,588 underwent RC, 839 received RT, 1,013 received CT, 1,035 had CRT, and 5580 had no further treatment. Mean age was 85.1 years (range, 80-90). 82.1% of patients had Stage II disease. Mean follow-up was 27.6 months (range, 0-137.8). Mean survival of the entire cohort was 28.0 months (95% CI, 27.2-28.8). Mean survival was 43.8 months (95% CI, 41.2-46.3) for patients with RC and 40.8 months (95% CI, 38.2-43.3) for CRT (P = 0.85). Mean survival was 29.1 months (95% CI, 26.8-31.4) and 30.7 months (95% CI, 28.2-33.2) for RT alone vs. CT alone, respectively (P < 0.0001 for both RC and CRT comparisons). 5-year OS for CT alone, RT alone, CRT, and RC was 15.7%, 15.1%, 24.0% and 29.6%, respectively. Multivariate analysis adjusting for age, year of diagnosis, gender, race, treatment location, treatment facility, insurance status, Charlson/Deyo Score, grade, and stage demonstrated an OS benefit in favor of CRT (HR 0.70; 95% CI, 0.63-0.77; P < 0.0001) and RC (HR 0.69; 95% CI, 0.63-0.76; P < 0.0001). Conclusions: For elderly patients with MIBC, both RC and CRT were associated with improved OS compared to CT or RT alone. CRT has similar OS compared to RC, and could be considered standard treatment in this population.