Impact of age >70 years on oncological outcomes in patients with non-muscle-invasive bladder cancer treated with Bacillus Calmette–Guérin

Roberto Contieri; Valentina Grajales; Wei Shen Tan; Alberto Martini; Akshay Sood; Patrick Hensley; Kelly Bree; Niyati Lobo; Graciela M. Nogueras-Gonzalez; Charles C. Guo; Neema Navai; Colin P. Dinney; Ashish M. Kamat

doi:10.1111/bju.16127

Impact of age >70 years on oncological outcomes in patients with non-muscle-invasive bladder cancer treated with Bacillus Calmette–Guérin

Roberto Contieri, Valentina Grajales, Wei Shen Tan, Alberto Martini, Akshay Sood, Patrick Hensley, Kelly Bree, Niyati Lobo, Graciela M. Nogueras-Gonzalez, Charles C. Guo, Neema Navai, Colin P. Dinney, Ashish M. Kamat

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

Objective: To evaluate the impact of age on oncological outcomes in a large contemporary cohort of patients with non-muscle-invasive bladder cancer (NMIBC) treated with adequate Bacillus Calmette–Guérin (BCG). Patients and Methods: We performed an Institutional Review Board-approved retrospective study analysing patients with NMIBC treated with adequate BCG at our institution from 2000 to 2020. Adequate BCG was defined as per United States Food and Drug Administration (FDA) guidelines as being receipt of at least five of six induction BCG instillations with a minimum of two additional doses (of planned maintenance or of re-induction) of BCG instillations within a span of 6 months. The study's primary outcome was to determine if age >70 years was associated with progression to MIBC cancer or distant metastasis. The cumulative incidence method and the competing-risk regression analyses were used to investigate the association of advanced age (>70 years) with progression, high-grade (HG) recurrence and cancer-specific mortality (CSM). Results: Overall, data from 632 patients were analysed: 355 patients (56.2%) were aged ≤70 years and 277 (43.8%) were >70 years. Age >70 years did not adversely affect either cumulative incidence of progression or HG recurrence (P = 0.067 and P = 0.644, respectively). On competing-risk regression analyses, age >70 years did not emerge as an independent predictor of progression or HG recurrence (sub-standardised hazard ratio [SHR] 1.57, 95% confidence interval [CI] 0.87–2.81, P = 0.134; and SHR 1.05, 95% CI 0.77–1.44, P = 0.749). Not unexpectedly, patients in the older group did have higher overall mortality (P < 0.001) but not CSM (P = 0.057). Conclusion: Age >70 years was not associated with adverse oncological outcomes in a large contemporary cohort of patients receiving adequate intravesical BCG for NMIBC. BCG should not be withheld from older patients seeking for bladder sparing options.

Original language	English
Pages (from-to)	63-70
Number of pages	8
Journal	BJU International
Volume	133
Issue number	1
DOIs	https://doi.org/10.1111/bju.16127
State	Published - Jan 2024

Bibliographical note

Publisher Copyright:
© 2023 BJU International.

Funding

Ashish M. Kamat certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g., employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Ashish M. Kamat is a consultant or advisory board member for Arquer Diagnostics, AstraZeneca, BioClin Therapeutics, Bristol Myers Squibb, CG Oncology, Eisai, Engene, Ferring Pharmaceuticals, Imagin Medical, Janssen, Medac, Merck, Pfizer, Photocure, Seattle Genetics, Theralase Technologies; has received grants and/or research support from Adolor Corporation, Bristol Myers Squibb, FKD Industries, Heat Biologics, Merck, Photocure, Southwest Oncology Group (SWOG)/National Institutes of Health (NIH), Specialized Programs of Research Excellence (SPORE), and Leo and Anne Albert Institute for Bladder Cancer and Research (AIBCCR); and holds the patent for Cytokine Predictors of Response to Intravesical Therapy (CyPRIT) jointly with the University of Texas MD Anderson Cancer Center. The other authors declare no competing interests. This research was supported by the Wayne B. Duddlesten Professorship in Cancer Research, the Raymond and Maria Floyd Bladder Cancer Research Foundation Grant to Ashish M. Kamat, and NIH/National Cancer Institute (NCI) University of Texas MD Anderson SPORE in Genitourinary Cancer (Bladder; P50CA091846) to Colin P. Dinney. Graciela M. Nogueras‐Gonzalez was supported by the Cancer Center Support Grant (NCI Grant P30 CA016672).

Funders	Funder number
AIBCCR
Adolor Corporation
BioClin Therapeutics
Markey Cancer Center's Cancer Center Support	P30 CA016672
FKD Industries
Leo and Anne Albert Institute for Bladder Cancer and Research
National Institutes of Health (NIH)
National Childhood Cancer Registry – National Cancer Institute	P50CA091846
National Childhood Cancer Registry – National Cancer Institute
Bristol-Myers Squibb
AstraZeneca
University of Texas Anderson Cancer Center

Keywords

Bacillus Calmette–Guérin
age
competing risk analysis
non-muscle-invasive bladder cancer
oncological outcomes
progression

ASJC Scopus subject areas

Urology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/bju.16127

Cite this

Contieri, R., Grajales, V., Tan, W. S., Martini, A., Sood, A., Hensley, P., Bree, K., Lobo, N., Nogueras-Gonzalez, G. M., Guo, C. C., Navai, N., Dinney, C. P., & Kamat, A. M. (2024). Impact of age >70 years on oncological outcomes in patients with non-muscle-invasive bladder cancer treated with Bacillus Calmette–Guérin. BJU International, 133(1), 63-70. https://doi.org/10.1111/bju.16127

@article{0f660a9dc9dc4f2e906094ee6a07b8da,

title = "Impact of age >70 years on oncological outcomes in patients with non-muscle-invasive bladder cancer treated with Bacillus Calmette–Gu{\'e}rin",

abstract = "Objective: To evaluate the impact of age on oncological outcomes in a large contemporary cohort of patients with non-muscle-invasive bladder cancer (NMIBC) treated with adequate Bacillus Calmette–Gu{\'e}rin (BCG). Patients and Methods: We performed an Institutional Review Board-approved retrospective study analysing patients with NMIBC treated with adequate BCG at our institution from 2000 to 2020. Adequate BCG was defined as per United States Food and Drug Administration (FDA) guidelines as being receipt of at least five of six induction BCG instillations with a minimum of two additional doses (of planned maintenance or of re-induction) of BCG instillations within a span of 6 months. The study's primary outcome was to determine if age >70 years was associated with progression to MIBC cancer or distant metastasis. The cumulative incidence method and the competing-risk regression analyses were used to investigate the association of advanced age (>70 years) with progression, high-grade (HG) recurrence and cancer-specific mortality (CSM). Results: Overall, data from 632 patients were analysed: 355 patients (56.2\%) were aged ≤70 years and 277 (43.8\%) were >70 years. Age >70 years did not adversely affect either cumulative incidence of progression or HG recurrence (P = 0.067 and P = 0.644, respectively). On competing-risk regression analyses, age >70 years did not emerge as an independent predictor of progression or HG recurrence (sub-standardised hazard ratio [SHR] 1.57, 95\% confidence interval [CI] 0.87–2.81, P = 0.134; and SHR 1.05, 95\% CI 0.77–1.44, P = 0.749). Not unexpectedly, patients in the older group did have higher overall mortality (P < 0.001) but not CSM (P = 0.057). Conclusion: Age >70 years was not associated with adverse oncological outcomes in a large contemporary cohort of patients receiving adequate intravesical BCG for NMIBC. BCG should not be withheld from older patients seeking for bladder sparing options.",

keywords = "Bacillus Calmette–Gu{\'e}rin, age, competing risk analysis, non-muscle-invasive bladder cancer, oncological outcomes, progression",

author = "Roberto Contieri and Valentina Grajales and Tan, \{Wei Shen\} and Alberto Martini and Akshay Sood and Patrick Hensley and Kelly Bree and Niyati Lobo and Nogueras-Gonzalez, \{Graciela M.\} and Guo, \{Charles C.\} and Neema Navai and Dinney, \{Colin P.\} and Kamat, \{Ashish M.\}",

note = "Publisher Copyright: {\textcopyright} 2023 BJU International.",

year = "2024",

month = jan,

doi = "10.1111/bju.16127",

language = "English",

volume = "133",

pages = "63--70",

number = "1",

}

Contieri, R, Grajales, V, Tan, WS, Martini, A, Sood, A, Hensley, P, Bree, K, Lobo, N, Nogueras-Gonzalez, GM, Guo, CC, Navai, N, Dinney, CP & Kamat, AM 2024, 'Impact of age >70 years on oncological outcomes in patients with non-muscle-invasive bladder cancer treated with Bacillus Calmette–Guérin', BJU International, vol. 133, no. 1, pp. 63-70. https://doi.org/10.1111/bju.16127

TY - JOUR

T1 - Impact of age >70 years on oncological outcomes in patients with non-muscle-invasive bladder cancer treated with Bacillus Calmette–Guérin

AU - Contieri, Roberto

AU - Grajales, Valentina

AU - Tan, Wei Shen

AU - Martini, Alberto

AU - Sood, Akshay

AU - Hensley, Patrick

AU - Bree, Kelly

AU - Lobo, Niyati

AU - Nogueras-Gonzalez, Graciela M.

AU - Guo, Charles C.

AU - Navai, Neema

AU - Dinney, Colin P.

AU - Kamat, Ashish M.

PY - 2024/1

Y1 - 2024/1

N2 - Objective: To evaluate the impact of age on oncological outcomes in a large contemporary cohort of patients with non-muscle-invasive bladder cancer (NMIBC) treated with adequate Bacillus Calmette–Guérin (BCG). Patients and Methods: We performed an Institutional Review Board-approved retrospective study analysing patients with NMIBC treated with adequate BCG at our institution from 2000 to 2020. Adequate BCG was defined as per United States Food and Drug Administration (FDA) guidelines as being receipt of at least five of six induction BCG instillations with a minimum of two additional doses (of planned maintenance or of re-induction) of BCG instillations within a span of 6 months. The study's primary outcome was to determine if age >70 years was associated with progression to MIBC cancer or distant metastasis. The cumulative incidence method and the competing-risk regression analyses were used to investigate the association of advanced age (>70 years) with progression, high-grade (HG) recurrence and cancer-specific mortality (CSM). Results: Overall, data from 632 patients were analysed: 355 patients (56.2%) were aged ≤70 years and 277 (43.8%) were >70 years. Age >70 years did not adversely affect either cumulative incidence of progression or HG recurrence (P = 0.067 and P = 0.644, respectively). On competing-risk regression analyses, age >70 years did not emerge as an independent predictor of progression or HG recurrence (sub-standardised hazard ratio [SHR] 1.57, 95% confidence interval [CI] 0.87–2.81, P = 0.134; and SHR 1.05, 95% CI 0.77–1.44, P = 0.749). Not unexpectedly, patients in the older group did have higher overall mortality (P < 0.001) but not CSM (P = 0.057). Conclusion: Age >70 years was not associated with adverse oncological outcomes in a large contemporary cohort of patients receiving adequate intravesical BCG for NMIBC. BCG should not be withheld from older patients seeking for bladder sparing options.

AB - Objective: To evaluate the impact of age on oncological outcomes in a large contemporary cohort of patients with non-muscle-invasive bladder cancer (NMIBC) treated with adequate Bacillus Calmette–Guérin (BCG). Patients and Methods: We performed an Institutional Review Board-approved retrospective study analysing patients with NMIBC treated with adequate BCG at our institution from 2000 to 2020. Adequate BCG was defined as per United States Food and Drug Administration (FDA) guidelines as being receipt of at least five of six induction BCG instillations with a minimum of two additional doses (of planned maintenance or of re-induction) of BCG instillations within a span of 6 months. The study's primary outcome was to determine if age >70 years was associated with progression to MIBC cancer or distant metastasis. The cumulative incidence method and the competing-risk regression analyses were used to investigate the association of advanced age (>70 years) with progression, high-grade (HG) recurrence and cancer-specific mortality (CSM). Results: Overall, data from 632 patients were analysed: 355 patients (56.2%) were aged ≤70 years and 277 (43.8%) were >70 years. Age >70 years did not adversely affect either cumulative incidence of progression or HG recurrence (P = 0.067 and P = 0.644, respectively). On competing-risk regression analyses, age >70 years did not emerge as an independent predictor of progression or HG recurrence (sub-standardised hazard ratio [SHR] 1.57, 95% confidence interval [CI] 0.87–2.81, P = 0.134; and SHR 1.05, 95% CI 0.77–1.44, P = 0.749). Not unexpectedly, patients in the older group did have higher overall mortality (P < 0.001) but not CSM (P = 0.057). Conclusion: Age >70 years was not associated with adverse oncological outcomes in a large contemporary cohort of patients receiving adequate intravesical BCG for NMIBC. BCG should not be withheld from older patients seeking for bladder sparing options.

KW - Bacillus Calmette–Guérin

KW - age

KW - competing risk analysis

KW - non-muscle-invasive bladder cancer

KW - oncological outcomes

KW - progression

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DO - 10.1111/bju.16127

M3 - Article

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AN - SCOPUS:85166636237

SN - 1464-4096

VL - 133

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JO - BJU International

JF - BJU International

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ER -

Impact of age >70 years on oncological outcomes in patients with non-muscle-invasive bladder cancer treated with Bacillus Calmette–Guérin

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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