The impact of age in patients with non-muscle-invasive bladder cancer treated with Bacillus Calmette-Guérin.
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Scilipoti Pietro, Zaurito Paolo, Longoni Mattia, Occhi Angelo, de Angelis Mario, Disabato Natasha, Tremolada Giovanni, Barracco Silvio, Ślusarczyk Aleksander, Soria Francesco, Krajewski Wojciech, D'Andrea David, Mari Andrea, Giudice Francesco Del, Pichler Renate, Subiela José Daniel, Marcq Gautier, Gallioli Andrea, Afferi Luca, Mastroianni Riccardo, Simone Giuseppe, Albisinni Simone, Mertens Laura S, Laukhtina Ekaterina, Oberneder Katharina, Elena José Luis Rodríguez, Aranda Javier, Puentedura Alfonso Lafuente, Velasco Jorge Caño, Contieri Roberto, Hurle Rodolfo, Mori Keiichiro, Radziszewski Piotr, Shariat Shahrokh F, Gontero Paolo, Rouprêt Morgan, Pradere Benjamin, Montorsi Francesco, Briganti Alberto, Moschini Marco, European Association of Urology - Young Academic Urologists (EAU-YAU), Urothelial carcinoma working group
Аннотация
METHODS: We retrospectively analyzed 1,741 patients with intermediate-, high-, or very high-risk non-muscle-invasive bladder cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG) at European tertiary referral centers between 2005 and 2024. Adequate BCG was defined according to International Bladder Cancer Group (IBCG) criteria. Multivariable linear, logistic, Cox, and Fine-Gray competing-risk regression models assessed the association between age and (1) BCG delivery and (2) recurrence, high-grade recurrence, progression, and cancer-specific mortality (CSM) among adequately treated patients, adjusting for standard clinicopathologic variables.
RESULTS: Among 1,317 (77%) patients with ≥1 year of follow-up and no early high-grade recurrence, increasing age was associated with lower BCG delivery (per 10 years: β -0.83 for number of instillations; OR 0.76 for adequate treatment; OR 0.87 for 1-year completion; all P < 0.05). Findings were similar when dichotomizing age at 70 years. No significant interaction was observed between age and BCG adequacy for oncological endpoints. Median follow-up was 40 months (IQR: 21-70). Among adequately treated patients (n = 1,296, 74%), 5-year risks for ≤70 vs. >70 years were comparable for any recurrence (28% vs. 30%; aHR: 1.12, 95% CI: 0.91-1.37), high-grade recurrence (22% vs. 25%; aHR: 1.27, 95% CI: 0.93-1.52), progression (11% vs. 13%; aHR: 1.04, 95% CI: 0.67-1.63), and CSM (5% vs. 8%; aHR: 1.90, 95% CI: 0.95-3.79).
CONCLUSIONS: Older age was associated with reduced adherence to BCG schedules, but not with worse oncological outcomes when adequate BCG was delivered. These findings indicate that age itself does not appear to diminish BCG effectiveness. Efforts to optimize treatment adherence, rather than age-based de-escalation, should be prioritized in the management of older NMIBC patients.