Cancer Management and Research (Feb 2022)
Comparative Study of Perioperative and Oncological Outcomes Between Elderly Patients and Younger Patients Who Received Radical Cystectomy and Pelvic Lymph Node Dissection: A Single-Center Retrospective Study
Abstract
Haixin Wang,1– 4,* Haiwen Huang,1– 3,* Meixia Shang,5 Han Hao,1– 3 Zhijun Xi1– 3 1Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China; 2Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People’s Republic of China; 3National Research Center for Genitourinary Oncology, Beijing, People’s Republic of China; 4Department of Urology, Yankuang New Journey General Hospital, Zoucheng, Shandong, People’s Republic of China; 5Department of Medical Statistics, Peking University First Hospital, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhijun Xi; Han Hao, Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, People’s Republic of China, Tel +86-10-83572481, Fax +86-10-66175710, Email [email protected]; [email protected]: To compare the perioperative and survival outcomes of patients over 75 years and younger patients who received radical cystectomy.Patients and methods: A total of 119 patients aged ≥ 75 years and 488 patients aged < 75 years were enrolled. All patients underwent radical cystectomy with pelvic lymph node dissection. Clinical characteristics and perioperative outcomes were compared between the two groups. Overall survival and progression-free survival were analyzed by using the Kaplan–Meier method. Cox regression analysis and logistic regression analysis were used to identify the risk factors affecting the outcomes observed.Results: There was no significant difference in perioperative complications between the elderly patient group and the younger patient group (p = 0.349). The 5-year overall survival of elderly patients was lower than that of young patients (p < 0.001). Age ≥ 75 years was a risk factor for overall survival (HR = 1.69 [95% CI: 1.22– 2.35]; p = 0.002) and progression-free survival (HR = 1.69 [95% CI: 1.14– 2.50]; p = 0.008) for patients who received radical cystectomy but was not a poor risk factor for major complications (HR = 1.25 [95% CI: 0.47– 3.31]; p = 0.658) after radical cystectomy. In addition, preoperative renal insufficiency was associated with a higher risk of major complications.Conclusion: In our cohort, compared with younger patients, elderly patients aged ≥ 75 years had worse survival outcomes, but age ≥ 75 years was not a risk factor for major complications after radical cystectomy with pelvic lymph node dissection. Radical surgery should be encouraged for elderly patients who can tolerate aggressive treatments.Keywords: radical cystectomy, elderly, survival outcomes, complications
