Non-muscle invasive urothelial bladder cancer (NMIBC) in very elderly patients: What does affect overall survival (OS)? Clinical outcomes in a retrospective analysis

Introduction & Objectives: Non-muscle invasive urothelial bladder cancer (NMIBC) represents a common neoplasm in patients older than 75 years old. Our aim was to analyze retrospectively the population of patients (pts) older than 85 years old treated at our department for bladder tumor. Primary outcome measures were the evaluation of overall survival (OS) and recurrence related to clinical-pathological features. Secondary outcome measures were the evaluation of any relation between treatmeants and OS. Materials & Methods: We looked retrospectively at 118 patients aged 85 years old or more who underwent transurethral resection (TURBT) for bladder tumor (BT) in our hospital between 2001 and 2015. We registered pre-operative clinical-pathological features and clinical outcomes. Statistical analysis was performed by SPSS. Results: A total of 47 females (39.8%) and 71 males (60.2%) with an a mean age of 88.13 (SD +/- 3.17) and mean ASA score 2.55 (+/- 0.5) were included in this study; 91 pts died (77.1%) and 27 (22.9%) are alive. Median time-to-death was 13.5 months (IQR 2-34) and median disease free survival (DFS) was 8 months (IQR 0-24). At diagnosis 28 pts already had advanced disease (23.72%). 4 pts underwent radical cistectomy (RC), 2 had partial cistectomy, 1 had radiotherapy for palliation and 110 had no further radical treatments (93.22%). Histotype was urothelial in 99 pts (83.89%), squamoid in 9 patients (7.62%) and undifferentiated in 10 cases (8.47%). 92 pts had no intravescical therapy (77.96%); 19 had BCG (16.1%) and 7 had MMC (5.93%). 79 pts had low grade (LG) disease (66.94%), 38 had high grade (HG) disease (32.20%) and 1 patient had CIS (0.84%). Among pts with HG disease 7 survived (18.4%) and 31 died (81.6%); among those with LG disease 20 survived (25.3%) and 59 died (74.7%). Among pts who received an intravescical treatment 33.33% survived; among those who did not received it 19.57% survived. Total recurrence rate was 38.14%. Conclusions: Bladder cancer is a well-known disease with an high rate of morbidity and mortality. In our series, HG grade disease, was not associated with higher mortality rate (81.6% vs 74,7% p=0.157) nor with recurrence rate (p=0.452). Tumor size and histotype seemed to be related to recurrence (p=0.001 and p=0.009 respectively). Intravescical treatment did not seemed to improve OS (p=0.06). Men seemed to have higher risk of recurrence (47.8% vs 23.4%, p=0.006). In the whole population recurrence seemed to not affect overall survival (p=0.72). Our study seems to demonstrate that clinico-pathological features of BT does not affect OS in very elderly pts. Further studies in larger cohorts of pts maybe needed.