Octogenarians with non-muscle-invasive bladder cancer (NMIBC) have the worst outcomes after bladder-preserving treatment, data show.

Researchers at Wakayama Medical University in Wakayama, Japan, studied 491 patients with primary NMIBC treated with transurethral resection and/or intravesical bacillus Calmette-Guérin (BCG). They classified subjects into age groups: younger than 50, 50-59, 60-69, 70-79, and 80 years and older.

At a median follow-up of 45 months, patients aged 80 years and older had the lowest recurrence-free survival (47.2% at two years) and progression-free survival (89.4% at two years) of all the age groups. Compared with patients aged 60-69 (reference group), those aged 80 years and older had a nearly 2.3 times increased risk of recurrence and a 2.8 times increased risk of progression, according to a findings published in the World Journal of Urology (2010;28:425-430). The investigators observed no increased risk of recurrence or progression in any of other age groups compared with the reference group.

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“A potential explanation for the poorer outcome observed in elderly patients could be their depressed baseline immune status and consequent inability to mount an immune reaction to BCG,” the authors noted. “In addition, aggressive tumor biology probably due to greater background genetic aberrations as well as decreased host immunological and other defense factors could lead to frequent recurrence in very elderly patients.”