Impact of age on outcomes of patients with pure carcinoma in situ of the bladder: multi-institutional cohort analysis

AIM AND OBJECTIVE: The aim of this multicenter study was to investigate the role of age (cut-off 70 years) at diagnosis in predicting oncologic behavior of pure carcinoma in situ of the bladder. MATERIAL AND METHODS: Inclusion criteria were: patients with pure CIS confirmed and that followed intravesical BCG treatment. Pure CIS was defined at any CIS not associated with another urothelial cancer. Exclusion criteria were: any CIS associated with invasive urothelial carcinoma. A total of 172 with pure CIS treated between 1stJanuary 2002 and 31st December 2012 at 8 academic institutions met the inclusion criteria. The maintenance schedule was generally according to the EAU guidelines at the time RESULTS: A total of 99 (57.6%) patients had an age >70 years prior to TURBT. There was no difference between clinico-pathological features among groups (group 1, age ≤70 years and group 2, age >70 years), except that patients aged ≤70 years presented a larger size of CIS (35.6% vs. 21.2%), p=0.02. In multivariable Cox regression analyses, the same clinico-pathological factors (age, multifocality and recurrent tumour state) were independently associated with worse RFS. Harrell's C-index was 65.75.In multivariable Cox regression analyses in addition to age (p=0.006) and multifocality (p<0.001) also BMI (p=0.04) was independently associated with worse PFS. Harrell's C-index was 74.71 CONCLUSIONS: Advanced age at diagnosis appears to be associated with an increased risk of recurrence and progression of pure carcinoma in situ of the bladder. Elderly patients might fail to respond to BCG therapy.