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

Figures & data

Table 1 The Clinicopathologic Characteristics of All Patients

	<75 Years (n =488)	≥75 Years (n =119)	p
Male	428 (87.7%)	99 (83.2%)	0.192
Age	62 (56–68)	77 (76–80)	<0.001
ORC	324 (66.4%)	88 (73.9%)	0.113
LRC	164 (33.6%)	31 (26.1%)
BMI (kg/m^2)	24.0 (22.0–26.5)	23.8 (21.5–26.1)	0.176
Preoperative renal insufficiency	35 (7.2%)	10 (8.4%)	0.646
ASA score			<0.001
1	46 (9.4%)	2 (1.7%)
2	400 (82.0%)	84 (70.6%)
3	41 (8.4%)	32 (26.9%)
4	1 (0.2%)	1 (0.8%)
Charlson comorbidity index			0.107
≤2	459 (94.1%)	107 (89.9%)
≥3	29 (5.9%)	12 (10.1%)
Type of urinary diversion			<0.001
Ureterocutaneostomy	71 (14.5%)	63 (52.9%)
Ileal conduit	384 (78.7%)	56 (47.1%)
Orthotopic neobladder	33 (6.8%)	0 (0%)
Time of operation (mins)	312.5 (245–383)	259 (216–335)	<0.001
EBL (L)	500 (200–1000)	500 (200–800)	0.626
Clavien-Dindo class			0.349
0	155 (31.8%)	33 (27.7%)
1	6 (1.2%)	2 (1.7%)
2	306 (62.7%)	77 (64.7%)
3	14 (2.9%)	4 (3.4%)
4	6 (1.2%)	3 (2.5%)
5	1 (0.2%)	0 (0%)
Major complication	21 (4.3%)	7 (5.9%)	0.462
Postoperative stay (days)	10 (8–14)	10 (8–17)	0.714
Clinical T stage			0.002
Ta and Tis and T1	94 (19.3%)	15 (12.6%)
T2	209 (42.8%)	40 (33.6%)
T3	134 (27.5%)	46 (38.7%)
T4	51 (10.5%)	18 (15.1%)
Pathological T stage			0.587
Ta and Tis and T1	139 (28.5%)	37 (31.1%)
T2	176 (36.1%)	42 (35.3%)
T3	107 (21.9%)	25 (21.0%)
T4	66 (13.5%)	15 (12.6%)
Pathological nodal stage			0.199
N0	395 (80.9%)	103 (86.6%)
N1	38 (7.8%)	4 (3.4%)
N2	43 (8.8%)	8 (6.7%)
N3	12 (2.5%)	4 (3.4%)
Pathologic grade			0.132
Low grade	50 (10.3%)	18 (15.1%)
High grade	437 (89.7%)	101 (84.9%)
Lymph node yield	11 (7–15)	8 (5–12)	0.225
Negative margin	483 (99.0%)	117 (98.3%)	0.628
Positive margin	5 (1.0%)	2 (1.7%)
No neoadjuvant/adjuvant chemotherapy	375 (76.8%)	110 (92.4%)	<0.001
Neoadjuvant/adjuvant chemotherapy	113 (23.2%)	9 (7.6%)

Note: Major complication: Clavien-Dindo class III–V.

Abbreviations: ORC, open radical cystectomy; LRC, laparoscopic radical cystectomy; BMI, Body Mass Index; EBL, estimated blood loss; ASA, American Society of Anesthesiologists.

Table 2 Multivariable Cox Regression Analysis of Variables Associated with Overall Survival and Progression-Free Survival for All Patients Received Radical Cystectomy

Variable	Overall Survival			Progression-Free Survival
	Hazard Ratio	95% CI	p	Hazard Ratio	95% CI	p
Age (years)
<75	-	referent	-	-	referent	-
≥75	1.69	1.22–2.35	0.002	1.69	1.14–2.50	0.008
ASA			0.023			0.637
1	-	referent	-	-	referent	-
2	2.10	0.98–4.50	0.057	1.43	0.72–2.83	0.308
3	3.15	1.38–7.21	0.006	1.70	0.77–3.76	0.194
4	5.93	0.70–50.01	0.102	1.51	0.19–12.28	0.702
Pathologic stage			<0.001			<0.001
Ta and Tis and T1	-	referent	-	-	referent	-
T2	1.38	0.90–2.09	0.137	1.43	0.88–2.32	0.147
T3	2.87	1.86–4.45	<0.001	2.86	1.74–4.68	<0.001
T4	3.27	2.05–5.23	<0.001	2.60	1.51–4.46	0.001
Pathologic nodal stage
N0	-	referent	-	-	referent	-
N+	1.97	1.41–2.75	<0.001	1.67	1.17–2.39	0.005
Major complications
No	-	referent	-	-	referent	-
Yes	2.71	1.56–4.70	<0.001	1.18	0.48–2.91	0.713
No chemotherapy	-	referent	-	-	referent	-
Chemotherapy	1.20	0.86–1.69	0.286	2.91	2.06–4.10	<0.001
Negative margin	-	referent	-	-	referent	-
Positive margin	0.40	0.06–2.89	0.366	0.38	0.05–2.72	0.332

Note: Major complication: Clavien-Dindo class III–V.

Abbreviation: ASA, American Society of Anesthesiologists.

Figure 1 Kaplan–Meier curves of OS probability (p < 0.001), PFS (p =0.131), and CSS probability (p = 0.065) in elderly patients and younger patients who received radical cystectomy and pelvic lymph node dissection. The 5-year OS of elderly patients and young patients was 0.456 versus 0.628, respectively. The 5-year PFS was 0.620 versus 0.670, and the 5-year CSS was 0.638 versus 0.725 in the elderly patient group and the young patient group, respectively.

Abbreviations: OS, overall survival; PFS, progression-free survival; CSS, cancer-specific survival.

Table 3 Univariable/Multivariable Cox Regression Analysis of Variables Associated with Overall Survival for Elderly Patients

Variable	Univariable Cox Regression Analysis			Multivariable Cox Regression Analysis
	Hazard Ratio	95% CI	p	Hazard Ratio	95% CI	p
Sex
Female	–	referent	–	–	referent	–
Male	4.099	1.473–11.403	0.007	4.005	1.394–11.505	0.010
Charlson comorbidity index
≤2	–	referent	–	–	referent	–
≥3	3.166	1.516–6.614	0.002	2.291	1.055–4.978	0.036
Type of urinary diversion
Ileal conduit	–	referent	–	–	referent	–
ureterocutaneostomy	1.666	0.949–2.925	0.075	1.842	1.018–3.333	0.043
Pathologic stage			0.011			0.185
Ta and Tis and T1	–	referent	–	–	referent	–
T2	1.116	0.540–2.306	0.766	1.598	0.725–3.519	0.245
T3	1.705	0.792–3.669	0.172	2.150	0.922–5.013	0.077
T4	3.445	1.530–7.756	0.003	2.626	1.038–6.646	0.042
Pathologic nodal stage
N0	–	referent	–	–	referent	–
N+	2.323	1.184–4.557	0.014	1.766	0.814–3.832	0.150
Major complications
No	–	referent	–	–	referent	–
Yes	4.459	1.865–10.660	0.001	5.047	1.867–13.644	0.001
Chemotherapy
Yes	–	referent	–	–	referent	–
No	2.012	0.856–4.729	0.109	1.941	0.797–4.726	0.144

Note: Major complication: Clavien-Dindo class III–V.

Table 4 Logistic Regression Analysis of Variables Associated with Major Complication for All Patients

	Odds Ratio	95% CI	p
Age (years)
<75	–	referent	–
≥75	1.25	0.47–3.31	0.658
Sex
Female	–	referent	–
Male	1.92	0.44–8.44	0.388
ASA			0.232
1	–	referent	–
2	1.68	0.22–13.21	0.620
3	4.35	0.48–39.51	0.191
4	–	–	–
Preoperative renal insufficiency
No	–	referent	–
Yes	4.33	1.64–11.38	0.003
Type of operation
ORC	–	referent	–
LRC	0.56	0.22–1.47	0.24
Type of urinary diversion			0.794
ureterocutaneostomy	–	referent	–
Ileal conduit	0.91	0.31–2.66	0.869
Orthotopic neobladder	1.58	0.21–11.99	0.659
Time of operation (continuous)	1.00	0.99–1.01	0.175

Abbreviations: ORC, open radical cystectomy; LRC, laparoscopic radical cystectomy; ASA, American Society of Anesthesiologists.