Elsevier

Urology

Volume 77, Issue 3, March 2011, Pages 660-666
Urology

Oncology
Perioperative Mortality Is Significantly Greater in Septuagenarian and Octogenarian Patients Treated With Radical Cystectomy for Urothelial Carcinoma of the Bladder

https://doi.org/10.1016/j.urology.2010.07.537Get rights and content

Objectives

To revisit whether the perioperative mortality differs between septuagenarian and octogenarian patients and younger patients in a large contemporary population-based cohort. The data from tertiary care centers have suggested that perioperative mortality after radical cystectomy is not considerably different in septuagenarian or octogenarian patients compared with younger patients. However, population-based data have stated otherwise.

Methods

From 1988 to 2006, 12 722 radical cystectomies were performed for urothelial carcinoma of the urinary bladder in 17 Surveillance, Epidemiology, and End Results registries. Of those 12 722 patients, 4480 (35.2%) were aged 70-79 years and 1439 (11.3%) were aged ≥80 years. Univariate and multivariate logistic regression models tested the 90-day mortality after radical cystectomy. Covariates consisted of sex, race, year of surgery, Surveillance, Epidemiology, and End Results registry, and histologic grade and stage.

Results

The overall 90-day mortality rate was 4% for the entire population, 2% for patients aged ≤69 years, 5.4% for septuagenarian patients, and 9.2% for octogenarian patients. In the multivariate logistic regression analyses, septuagenarian (odds ratio 2.80; P < .001) and octogenarian (odds ratio 5.02; P < .001) age increased the risk of 90-day mortality after radical cystectomy.

Conclusions

In the present population-based analysis, the perioperative mortality after radical cystectomy was three- and fivefold greater in the septuagenarian and octogenarian patients, respectively, which was greater than that in tertiary care centers. This information should be included in informed consent considerations.

Section snippets

Study Population

Within the Surveillance, Epidemiology, and End Results (SEER)-17 registry database, we identified 14 240 patients who had undergone RC for nonmetastatic (M0) UCUB (“International Classification of Diseases, 9th revision,” codes C670-679 and 812 and 813 histologic codes) from 1988 to 2006. The SEER population represents a 26% sample of the U.S. population and is considered representative of the entire U.S. population in terms of demographics, cancer incidence, and mortality rate.7 The 17

Results

Of the 12 722 patients who underwent RC for UCUB, 4480 (35.2%) were septuagenarians and 1439 (11.3%) were octogenarians. The overall mean age was 67.4 years (median 69, range 17-100). Most of the patients were male (74.8%) and white (90.0%). Most patients underwent RC in the most contemporary year quartile (26.2%), and most had presented with a high histologic grade (grade 3-4, 89.1%) and a regional (nonlocalized) stage (84.8%).

Table 1 lists the clinical and pathologic features of the overall

Comment

Despite the existence of several reports that suggest little differences in POM between elderly and younger patients, we decided to examine the POM rates according to age in a large population-based cohort. The rationale for performing this type of analysis stemmed from the small sample sizes of most previous contributions. For example, 11 investigators relied on series that had included <100 septuagenarians.8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 Similarly, 17 investigators relied on <50

Conclusions

In the present population-based analysis, POM showed a three- and fivefold increase in septuagenarian and octogenarian patients, respectively, relative to patients aged ≤69 years. These important increases in the risk of POM should be communicated to elderly RC candidates, especially those with existing important comorbidities. The consideration of these rates does not imply that RC should no longer be considered as the ideal treatment option. However, the POM rates we have reported should be

References (31)

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    There is some evidence to suggest increasing perioperative mortality with advancing age for patients undergoing radical cystectomy. Liberman and colleagues analyzed radical cystectomy outcomes from the SEER database.106 Of 12,722 patients undergoing cystectomy, 4480 and 1439 were performed in patients ages 70-79 years and 80+ years, respectively.

  • Carcinoma of the Bladder

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P. I. Karakiewicz was partially supported by the University of Montréal Urology Associates, Fonds de la Recherche en Santé du Québec, the University of Montréal Department of Surgery, and the University of Montréal Foundation.

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