Abstract
Introduction: To examine national trends of radical cystectomy (RC) for urothelial carcinoma of urinary bladder in octogenarian patients and to assess the rates of adverse outcomes. Materials and Methods: Within the Nationwide Inpatient Sample (NIS), we focused on RCs performed between 1998 and 2007. Age was stratified as <80 versus ≥80 years. Propensity-based matched analyses were used to account for treatment selection biases. Generalized linear regression analyses were fitted to predict adverse perioperative events according to age. Results: Of 12,274 RC patients, 1,605 were ≥80 years (13.1%). The RC rates in octogenarians increased significantly from 9.9% in 1998 to 13.7% in 2007. Most elderly patients were treated at low-/intermediate-volume hospitals (81.7%) and nonacademic centers (60.6%). After propensity score matching, the inpatient mortality rate was higher in octogenarians (4.6 vs. 2.6%, p < 0.001). In multivariable analyses, octogenarians were at increased risk of blood transfusions (OR: 1.30) and postoperative complications (OR: 1.22). Conclusions: Most octogenarians undergoing RC are treated at low-/intermediate-volume hospitals and at nonacademic centers. The inpatient hospital mortality is about twice as high in these patients, and adverse perioperative outcomes are more frequent. Such patients may benefit from RC at high-volume and/or academic centers to maximally reduce adverse perioperative outcomes.
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References
1.
Jemal A, Siegel R, Xu J, Ward E: Cancer statistics, 2010. CA Cancer J Clin 2010;60:277-300.
[PubMed]
2.
Montie JE, Clark PE, Eisenberger MA, El-Galley R, Greenberg RE, Herr HW, Hudes GR, Kuban DA, Kuzel TM, Lange PH, Lele SM, Michalski J, Patterson A, Pohar KS, Richie JP, Sexton WJ, Shipley WU, Small EJ, Trump DL, Walther PJ, Wilson TG: Bladder cancer. J Natl Compr Canc Netw 2009;7:8-39.
[PubMed]
3.
Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, Skinner E, Bochner B, Thangathurai D, Mikhail M, Raghavan D, Skinner DG: Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 2001;19:666-675.
[PubMed]
4.
Lughezzani G, Sun M, Shariat SF, Budaus L, Thuret R, Jeldres C, Liberman D, Montorsi F, Perrotte P, Karakiewicz PI: A population-based competing-risks analysis of the survival of patients treated with radical cystectomy for bladder cancer. Cancer 2011;117:103-109.
[PubMed]
5.
Hollenbeck BK, Miller DC, Taub D, Dunn RL, Underwood W 3rd, Montie JE, Wei JT: Aggressive treatment for bladder cancer is associated with improved overall survival among patients 80 years old or older. Urology 2004;64:292-297.
[PubMed]
6.
Clark PE, Stein JP, Groshen SG, Cai J, Miranda G, Lieskovsky G, Skinner DG: Radical cystectomy in the elderly: comparison of clincal outcomes between younger and older patients. Cancer 2005;104:36-43.
[PubMed]
7.
Donat SM, Siegrist T, Cronin A, Savage C, Milowsky MI, Herr HW: Radical cystectomy in octogenarians - does morbidity outweigh the potential survival benefits? J Urol 2010;183:2171-2177.
[PubMed]
8.
Froehner M, Brausi MA, Herr HW, Muto G, Studer UE: Complications following radical cystectomy for bladder cancer in the elderly. Eur Urol 2009;56:443-454.
[PubMed]
9.
Konety BR, Joslyn SA: Factors influencing aggressive therapy for bladder cancer: an analysis of data from the SEER program. J Urol 2003;170:1765-1771.
[PubMed]
10.
Trinh QD, Schmitges J, Sun M, Shariat SF, Sukumar S, Tian Z, Bianchi M, Sammon J, Perrotte P, Rogers CG, Graefen M, Peabody JO, Menon M, Karakiewicz PI: Open radical prostatectomy in the elderly: a case for concern? BJU Int 2012;109:1335-1340.
[PubMed]
11.
Clark PE, Stein JP, Groshen SG, Cai J, Miranda G, Lieskovsky G, Skinner DG: Radical cystectomy in the elderly: comparison of survival between younger and older patients. Cancer 2005;103:546-552.
[PubMed]
12.
Nielsen ME, Shariat SF, Karakiewicz PI, Lotan Y, Rogers CG, Amiel GE, Bastian PJ, Vazina A, Gupta A, Lerner SP, Sagalowsky AI, Schoenberg MP, Palapattu GS: Advanced age is associated with poorer bladder cancer-specific survival in patients treated with radical cystectomy. Eur Urol 2007;51:699-706, discussion 706-708.
[PubMed]
13.
Schrag D, Mitra N, Xu F, Rabbani F, Bach PB, Herr H, Begg CB: Cystectomy for muscle-invasive bladder cancer: patterns and outcomes of care in the Medicare population. Urology 2005;65:1118-1125.
[PubMed]
14.
Prout GR Jr, Wesley MN, Yancik R, Ries LA, Havlik RJ, Edwards BK: Age and comorbidity impact surgical therapy in older bladder carcinoma patients: a population-based study. Cancer 2005;104:1638-1647.
[PubMed]
15.
Novotny V, Hakenberg OW, Froehner M, Zastrow S, Leike S, Koch R, Wirth MP: Systematic assessment of complications and outcome of radical cystectomy undertaken with curative intent in patients with comorbidity and over 75 years of age. Urol Int 2013;90:195-201.
[PubMed]
16.
HCUP Nationwide Inpatient Sample (NIS). Healthcare cost and utilization project (HCUP) 1998-2007. Agency for Healthcare Research and Quality, Rockville, Md. http://www.hcup-us.ahrq.gov/nisoverview.jsp.
17.
Deyo RA, Cherkin DC, Ciol MA: Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613-619.
[PubMed]
18.
Bianchi M, Trinh QD, Sun M, Sammon J, Schmitges J, Shariat SF, Sukumar S, Ghani KR, Jeldres C, Perrotte P, Rogers CG, Briganti A, Peabody JO, Montorsi F, Menon M, Karakiewicz PI: Discharge patterns after radical cystectomy: contemporary trends in the United States. J Urol 2012;187:1206-1209.
[PubMed]
19.
Darling DA: The Kolmogorov-Smirnov, Cramer-V Mises tests. Ann Math Stat 1957;28:823-838.
20.
Shapiro SS, Wilk MB: An analysis of variance test for normality (complete samples). Biometrika 1965;52:591-611.
21.
D'Agostino RB Jr: Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 1998;17:2265-2281.
[PubMed]
22.
Stukel TA, Fisher E, Wennberg DE, Alter DA, Gottlieb DJ, Vermeulen MJ: Analysis of observational studies in the presence of treatment selection bias: effects of invasive cardiac management on AMI survival using propensity score and instrumental variable methods. JAMA 2007;297:278-285.
[PubMed]
23.
Panageas KS, Schrag D, Riedel E, Bach PB, Begg CB: The effect of clustering of outcomes on the association of procedure volume and surgical outcomes. Ann Intern Med 2003;139:658-665.
[PubMed]
24.
Aboumarzouk OM, Drewa T, Olejniczak P, Chlosta PL: Laparoscopic versus open radical cystectomy for muscle-invasive bladder cancer: a single institute comparative analysis. Urol Int 2013;91:109-112.
[PubMed]
25.
Hollenbeck BK, Miller DC, Taub D, Dunn RL, Khuri SF, Henderson WG, Montie JE, Underwood W 3rd, Wei JT: Identifying risk factors for potentially avoidable complications following radical cystectomy. J Urol 2005;174:1231-1237, discussion 1237.
[PubMed]
26.
Gore JL, Litwin MS, Lai J, Yano EM, Madison R, Setodji C, Adams JL, Saigal CS: Use of radical cystectomy for patients with invasive bladder cancer. J Natl Cancer Inst 2010;102:802-811.
[PubMed]
27.
Froehner M, Scholz A, Koch R, Hakenberg OW, Baretton GB, Wirth MP: Competing mortality contributes to excess mortality in patients with poor-risk lymph node-positive prostate cancer treated with radical prostatectomy. Urol Int 2012;89:148-154.
[PubMed]
28.
Roghmann F, Noldus J, von Bodman C, Holz A, Brock M, Palisaar J: Cystectomy in elderly patients: analysis of complications using the Clavien-Dindo classification (in German). Urologe A 2012;51:1386-1392.
[PubMed]
29.
Goossens-Laan CA, Gooiker GA, van Gijn W, Post PN, Bosch JL, Kil PJ, Wouters MW: A systematic review and meta-analysis of the relationship between hospital/surgeon volume and outcome for radical cystectomy: an update for the ongoing debate. Eur Urol 2011;59:775-783.
[PubMed]
30.
Hollenbeck BK, Dunn RL, Miller DC, Daignault S, Taub DA, Wei JT: Volume-based referral for cancer surgery: informing the debate. J Clin Oncol 2007;25:91-96.
[PubMed]
© 2013 S. Karger AG, Basel
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