Aggressive treatment for bladder cancer is associated with improved overall survival among patients 80 years old or older
Aggressive treatment for bladder cancer is associated with improved overall survival among patients 80 years old or older
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DOI：
10.1016/j.urology.2004.03.034
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发表时间：
2004-08-01
期刊：
影响因子：
2.1
通讯作者：
Wei, JT
中科院分区：
文献类型：
--
作者：
Hollenbeck, BK;Miller, DC;Wei, JT
目标.研究各种治疗方式对80岁或80岁以上膀胱癌患者生存率的影响，并与年轻患者进行比较。一个证据汇编表明，膀胱癌手术是安全的，在老年人;然而，这种治疗的好处，在人口的预期寿命有限，还没有得到很好的记录。从1988年至1999年期间国家癌症研究所的监测、流行病学和最终结果癌症登记处确定初步诊断为膀胱癌的受试者。在13，796名被诊断患有膀胱癌的患者中，24%的患者年龄超过80岁。进行比例风险回归模型以确定治疗策略对总体生存率和膀胱癌生存率的独立相关性，同时调整多个协变量。在80岁或以上的患者中，膀胱癌管理包括观察等待（7%），单纯放疗（M），全部或部分膀胱切除术（12%）和经尿道切除术（79%）。80岁或以上的患者比年轻患者更不可能接受摘除性手术治疗（P <0.0001）。考克斯比例风险模型显示，在80岁或以上的患者中，根治性膀胱切除术/部分膀胱切除术在膀胱癌死亡（风险比0.3）和全因死亡（风险比0.4）的主要治疗方式中风险降低最大（均P <0.0001）。年轻和老年膀胱癌患者之间的实践模式存在差异。我们提供了令人信服的证据表明，积极的膀胱癌手术治疗可以提高这些患者的生存率。应使用风险调整工具来识别通过不太积极的管理可以得到更好服务的患者（年轻和老年）。(C)2004年爱思唯尔公司
Objectives. To examine the impact of various treatment modalities on survival among patients with bladder cancer who were 80 years old or older compared with younger patients. A compendium of evidence suggests that bladder cancer surgery is safe among octogenarians; however, the benefit of such treatment in a population with limited life expectancy has not been well documented.Methods. Subjects with the primary diagnosis of bladder cancer were identified from the National Cancer Institute's Surveillance, Epidemiology, and End Results cancer registry between 1988 and 1999. Of the 13,796 patients diagnosed with bladder cancer, 24% were older than 80 years of age. Proportional hazards regression modeling was performed to determine the independent association of treatment strategy on overall and bladder cancer survival while adjusting for multiple covariates.Results. Of patients 80 years old or older, bladder cancer management included watchful waiting (7%), radiotherapy alone (M), full or partial cystectomy (12%), and transurethral resection (79%). Patients 80 years old or older were less likely to be treated with extirpative surgery than their younger counterparts (P < 0.0001). Cox proportional hazards models demonstrated that, among patients 80 years old or older, radical cystectomy/partial cystectomy had the greatest risk reduction in death from bladder cancer (hazard ratio 0.3) and death from any cause (hazard ratio 0.4) among the primary treatment modalities (both P < 0.0001).Conclusions. Disparities in practice patterns between younger and geriatric patients with bladder cancer exist. We provide compelling evidence that aggressive surgical management of bladder cancer in these patients may improve survival. Risk adjustment tools should be used to identify patients (young and old) who would be better served by less aggressive management. (C) 2004 Elsevier Inc.