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. 2024 Aug 31;13(8):1486-1497.
doi: 10.21037/tau-24-139. Epub 2024 Aug 16.

A comparative study of survival outcomes between partial and radical cystectomy in octogenarians with muscle-invasive bladder cancer

Arjun Pon Avudaiappan  1 , Pushan Prabhakar  1 , Ciara Lusnia  2 , Mohmmad Arfat Ganiyani  1 , Muni Rubens  1 , Rohan Garje  1 , Ahmed Eldefrawy  1   2 , Murugesan Manoharan  1   2
Affiliations

A comparative study of survival outcomes between partial and radical cystectomy in octogenarians with muscle-invasive bladder cancer

Arjun Pon Avudaiappan et al. Transl Androl Urol. .

Abstract

Background: Neoadjuvant chemotherapy with radical cystectomy (RC) is the preferred first-line treatment for localized muscle-invasive bladder cancer (MIBC). Due to the concern about morbidity associated with RC, the elderly population considers bladder preservation alternatives. Guidelines suggest partial cystectomy (PC) can be considered a viable option in carefully selected individuals. We used the National Cancer Database (NCDB) to compare the overall survival (OS) among octogenarians treated with PC and RC.

Methods: Using NCDB, we retrospectively evaluated individuals aged 80 years and above diagnosed with localized MIBC (cT2-4aN0M0) with tumor size less than 5 cm and urothelial histology between 2004 and 2018. Our primary cohort was divided into the RC cohort, which included patients who underwent RC with or without chemotherapy/radiotherapy, and the PC cohort, which included those who underwent PC. After propensity-matching, we compared the OS.

Results: Of 94,104 patients with MIBC, 2,528 octogenarians met our selection criteria. Among them, 313 were treated with PC, and 2,215 were treated with RC. A total of 151 (48.2%) PC patients had pelvic lymph node dissection, while 1,967 (88.8%) RC patients had lymph node dissection (P<0.001). The OS for matched PC and RC was 33.4 and 29.9 months, respectively (P=0.68). In T2 tumors, the OS for PC and RC was 37 and 33.5 months, respectively (P=0.52); for T3 tumors, the OS was 22.3 and 24.4 months, respectively (P=0.98).

Conclusions: Our study compared PC and RC in octogenarians with localized MIBC and observed that PC is safe and not inferior to RC in carefully selected octogenarians. The role of PC needs further exploration by comparing or integrating with strategies like concurrent chemoradiation to improve the oncological and survival outcomes.

Keywords: Muscle-invasive bladder cancer (MIBC); bladder preservation strategies; octogenarians; partial cystectomy (PC); radical cystectomy (RC).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-24-139/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study population of our final analysis. MIBC, muscle-invasive bladder cancer; PC, partial cystectomy; RC, radical cystectomy.
Figure 2
Figure 2
Overall survival comparing PC and RC among octogenarians. PC, partial cystectomy; RC, radical cystectomy.
Figure 3
Figure 3
Overall survival comparing PC and RC among octogenarians based on tumor stage. PC, partial cystectomy; RC, radical cystectomy.
See this image and copyright information in PMC

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