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Abstract：
BACKGROUND: Radical cystectomy (RC) is the standard treatment for muscle invasive bladder cancer, but approximately half of all patients will ultimately succumb to disease progression despite apparent cure with extirpative surgery. Elderly patients are at especially high risk of advanced disease and may benefit from perioperative systemic therapy.
OBJECTIVE: To assess the real-world benefit of adjuvant chemotherapy (AC) in patients ≥75 years old.
METHODS: We retrospectively reviewed patients who underwent RC for non-metastatic urothelial carcinoma of the bladder (UCB) from 12 participating international medical institutions. Kaplan-Meier survival curves and Cox regression models were used to assess the association between age groups, administration of AC and oncological outcome parameters such as recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS).
RESULTS: 4,335 patients were included in the analyses, of which 820 (18.9%) were ≥75 years old. These elderly patients had a higher rate of adverse pathologic features. In an univariable subgroup analysis in patients ≥75 years with lymph node metastasis, 5-year OS was significantly higher in patients who had received AC (41% vs. 30.9%, p = 0.02). In a multivariable Cox model that was adjusted for several established outcome predictors, there was a significant favorable association between the administration of AC in elderly patients and OS, but no RFS or CSS.
CONCLUSIONS: In this large observational study, the administration of AC was associated with improved OS, but not RFS or CSS, in elderly patients treated with RC for UCB. This is of clinical importance, as elderly patients are more likely to have adverse pathologic features and experience worse survival outcomes. Treatment of UCB should include both a multidisciplinary approach and a geriatric evaluation to identify patients who are most likely to tolerate and benefit from AC.
OBJECTIVE: To assess the real-world benefit of adjuvant chemotherapy (AC) in patients ≥75 years old.
METHODS: We retrospectively reviewed patients who underwent RC for non-metastatic urothelial carcinoma of the bladder (UCB) from 12 participating international medical institutions. Kaplan-Meier survival curves and Cox regression models were used to assess the association between age groups, administration of AC and oncological outcome parameters such as recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS).
RESULTS: 4,335 patients were included in the analyses, of which 820 (18.9%) were ≥75 years old. These elderly patients had a higher rate of adverse pathologic features. In an univariable subgroup analysis in patients ≥75 years with lymph node metastasis, 5-year OS was significantly higher in patients who had received AC (41% vs. 30.9%, p = 0.02). In a multivariable Cox model that was adjusted for several established outcome predictors, there was a significant favorable association between the administration of AC in elderly patients and OS, but no RFS or CSS.
CONCLUSIONS: In this large observational study, the administration of AC was associated with improved OS, but not RFS or CSS, in elderly patients treated with RC for UCB. This is of clinical importance, as elderly patients are more likely to have adverse pathologic features and experience worse survival outcomes. Treatment of UCB should include both a multidisciplinary approach and a geriatric evaluation to identify patients who are most likely to tolerate and benefit from AC.
摘要：
背景：根治性膀胱切除术（RC）是肌层浸润性膀胱癌的标准治疗方法，但是，尽管通过根治性手术明显治愈，但大约一半的患者最终仍将死于疾病进展。老年患者的晚期疾病风险尤其高，可能从围手术期全身治疗中受益。
目的：评估75岁以上患者辅助化疗（AC）的实际获益。
方法：我们回顾性分析了来自12个参与的国际医疗机构的因膀胱非转移性尿路上皮癌（UCB）而接受RC的患者。Kaplan-Meier存活曲线和Cox回归模型用于评估年龄组之间的关联。AC和肿瘤结果参数的管理，如无复发生存期（RFS），癌症特异性生存率（CSS）和总生存率（OS）。
结果：4,335名患者被纳入分析，其中820人(18.9%)≥75岁。这些老年患者的不良病理特征发生率较高。在淋巴结转移≥75岁患者的单变量亚组分析中，接受AC治疗的患者的5年OS明显更高(41%vs.30.9%,p=0.02)。在针对几个既定结果预测因子进行调整的多变量Cox模型中，老年患者的AC管理与OS之间存在显著的有利关联，但没有RFS或CSS。
结论：在这项大型观察性研究中，AC的管理与改进的OS相关，但不是RFS或CSS，在接受RC治疗UCB的老年患者中。这具有临床重要性,因为老年患者更有可能出现不良病理特征,并且生存结局更差.UCB的治疗应包括多学科方法和老年评估，以确定最有可能耐受AC并从中受益的患者。
目的：评估75岁以上患者辅助化疗（AC）的实际获益。
方法：我们回顾性分析了来自12个参与的国际医疗机构的因膀胱非转移性尿路上皮癌（UCB）而接受RC的患者。Kaplan-Meier存活曲线和Cox回归模型用于评估年龄组之间的关联。AC和肿瘤结果参数的管理，如无复发生存期（RFS），癌症特异性生存率（CSS）和总生存率（OS）。
结果：4,335名患者被纳入分析，其中820人(18.9%)≥75岁。这些老年患者的不良病理特征发生率较高。在淋巴结转移≥75岁患者的单变量亚组分析中，接受AC治疗的患者的5年OS明显更高(41%vs.30.9%,p=0.02)。在针对几个既定结果预测因子进行调整的多变量Cox模型中，老年患者的AC管理与OS之间存在显著的有利关联，但没有RFS或CSS。
结论：在这项大型观察性研究中，AC的管理与改进的OS相关，但不是RFS或CSS，在接受RC治疗UCB的老年患者中。这具有临床重要性,因为老年患者更有可能出现不良病理特征,并且生存结局更差.UCB的治疗应包括多学科方法和老年评估，以确定最有可能耐受AC并从中受益的患者。
