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The natural history of muscle-invasive bladder cancer in geriatric patients undergoing transurethral resection only: Outcome and cost.
Degener, Stephan; Dreger, Nici Markus; Gödde, Daniel; Dotse, Judith; Roth, Stephan; Heppner, Hans Jürgen; Lefering, Rolf; von Rundstedt, Friedrich-Carl.
Afiliación
  • Degener S; Department of Urology, Helios University Hospital Wuppertal, University of Witten/Herdecke, Germany. Electronic address: stephan.degener@helios-gesundheit.de.
  • Dreger NM; Department of Urology, Helios University Hospital Wuppertal, University of Witten/Herdecke, Germany.
  • Gödde D; Department of Pathology, Helios University Hospital Wuppertal, University of Witten/Herdecke, Germany.
  • Dotse J; Department of Urology, Helios University Hospital Wuppertal, University of Witten/Herdecke, Germany.
  • Roth S; Department of Urology, Helios University Hospital Wuppertal, University of Witten/Herdecke, Germany.
  • Heppner HJ; Department of Geriatrics, Helios Hospital Schwelm, University of Witten/Herdecke, Germany.
  • Lefering R; Institute for Research in Operative Medicine, IFOM, University of Witten/Herdecke, Cologne, Germany.
  • von Rundstedt FC; Department of Urology, Helios University Hospital Wuppertal, University of Witten/Herdecke, Germany.
Urol Oncol ; 39(5): 300.e7-300.e13, 2021 05.
Article en En | MEDLINE | ID: mdl-33308977
ABSTRACT

PURPOSE:

Bladder cancer is predominant in the elderly. Up to 70% of geriatric patients with muscle-invasive bladder cancer do not receive curative treatment. We analyzed the outcome of patients managed only by transurethral resection of bladder tumor (TURBT) without chemo- or radio-therapy, and performed a cost analysis of the cumulative inpatient interventions throughout the course of the disease.

METHODS:

From 2010 to 2016 81 patients ≥75 years with de novo muscle-invasive bladder cancer who were not eligible for curative treatment options were analyzed retrospectively. All patients were treated only with TURBT. Overall survival (OS) was measured by Kaplan-Meier plots (log-rank test) and clinical parameters predicting OS by a multivariate analysis. The cost analysis was based on actual billing from the hospital provider and referenced standardized pricing in Germany for bladder cancer treatment.

RESULTS:

The median age was 83 years. The OS was 11 months, the 1-year OS was 42%. In the multivariate model Charlson Comorbidity Index <8 (P = 0.016), tumor size ≤3 cm (P = 0.011), complete (T0) tumor resection (P = 0.003), normal C-reactive protein level (P = 0.010), and initial elective surgery (P = 0.035) were shown to be independent predictors of longer OS in palliative TURBT regimes. Median treatment cost for the TURBT regimen was $16,175 vs. $16,467 for a salvage radical cystectomy in this cohort.

CONCLUSIONS:

In a TURBT-only concept elective surgery, tumor size, Charlson Comorbidity Index, C-reactive protein level and complete TURBT are independent predictors of OS. The treatment-related cumulative cost appears to be higher in patients not managed by cystectomy.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Neoplasias de la Vejiga Urinaria / Cistectomía / Costos y Análisis de Costo Tipo de estudio: Health_economic_evaluation / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: Urol Oncol Asunto de la revista: NEOPLASIAS / UROLOGIA Año: 2021 Tipo del documento: Article

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Neoplasias de la Vejiga Urinaria / Cistectomía / Costos y Análisis de Costo Tipo de estudio: Health_economic_evaluation / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: Urol Oncol Asunto de la revista: NEOPLASIAS / UROLOGIA Año: 2021 Tipo del documento: Article