MP63-11: Advanced Age (>70 Years) Does not Affect Oncological Outcomes in Non-Muscle Invasive Bladder Cancer Patients Treated with Adequate Bacillus Calmette-Guerin: A Competing Risk Analysis from a Tertiary Care Center.
Introduction: According to the newly released European Association of Urology (EAU) prognostic factor risk groups, age over 70 should be considered an additional clinical risk factor for progression amongst patients with non-muscle invasive bladder cancer (NMIBC). However, this statement is based on an analysis of patients who did not receive intravesical BCG therapy. Herein, we aim to evaluate the impact of age on oncological outcomes in NMIBC patients treated with adequate BCG. Methods: We performed an IRB approved retrospective study analyzing patients with NMIBC treated with adequate BCG at our institution from 2000 to 2020. Based on EAU guidelines, patients were stratified into two groups according to age ( <70 yrs and >70 yrs). Primary endpoint was cancer-specific mortality (CSM). The cumulative incidence method was used to estimate the risk of CSM, high-grade (HG) recurrence and progression to muscle-invasive BC or metastatic disease after accounting for other causes of death (OCD) as a competing risk event; curves were compared with the Pepe-Mori test. Multivariate competing-risks regression analyses were used to predict HG recurrence and progression according to age after accounting for OCD. Results: A total of 632 patients treated with adequate BCG were identified (355 <70 yrs versus 277 >70 yrs). The median follow-up was 64.6 months (Interquartile range: 35.3 – 99.4) . Older patients were more likely to have a concomitant CIS (29.0% vs. 35.7%, p=0.072), and less likely to undergo second resection (reTUR) (66.2% vs. 56.5%, p=0.013). Despite this, at multivariate competing-risk regression analyses, age >70 did not emerge as an independent predictor of HG recurrence or progression (SHR 1.07, 95%CI: 0.78 – 1.46; p=0.687 and SHR: 1.60; 95%CI: 0.89 – 2.89; p=0.118). OS at 5 (94.2% vs. 78.5%) and 10 years (81.1% vs 42.3%) was considerably lower in the >70 yrs group. However, the 5-yr CSM overlap between the age groups (5.1% 95%CI: 2.7 - 8.7 vs. 2.0% 95%CI: 0.8 – 4.2). Conclusions: Age >70 was not associated with significantly worse oncological outcomes in NMIBC patients treated with adequate BCG SOURCE OF Funding: This research was supported by the Wayne B. Duddlesten Professorship in Cancer Research, the Raymond and Maria Floyd Bladder Cancer Research Foundation Grant, NIH/NCI UTMD Anderson SPORE in Genitourinary Cancer (P50CA091846), the Cancer Center Support Grant (NCI Grant P30 CA016672).
