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Preoperative Chemotherapy for Muscle-Invasive Bladder Cancer: Is Age Related to Response?

By: Joseph Fanelli
Posted: Wednesday, October 6, 2021

According to findings presented in the World of Urology, age does not appear to be associated with response to preoperative chemotherapy in patients with muscle-invasive bladder cancer. The use of preoperative chemotherapy, then, should be considered regardless of a patient’s age, concluded Shahrokh F. Shariat, MD, of the Medical University of Vienna, and colleagues.

“While the TCGA [The Cancer Genome Atlas] analysis showed that younger patients may have less mutational tumor burden, this factor may not translate into response to preoperative chemotherapy, and further research is needed into the impact of genetic factors and response to systemic therapy,” the authors added.

In this trial, the authors evaluated patient data from 1,105 people who received preoperative chemotherapy followed by radical cystectomy and lymphadenectomy between 2000 and 2013. No patients included had clinically distant metastases on preoperative imaging. Additionally, records from 395 patients in The Cancer Genome Atlas were used to investigate the prevalence of molecular subtypes and DNA damage repair gene alterations based on patients’ age.

The authors found that pathologic objective response occurred in 40% of patients, and there seemed to be no difference in distribution of pathologic objective response or complete response when age quartiles were compared. On univariable logistic regression, a patient’s age was also not found to be associated with pathologic objective response or complete response when the authors evaluated them as continuous variables or stratified them in quartiles.

Cox regression and competing risk regression analysis revealed that age was not associated with survival outcomes. Additionally, the authors discovered higher age distributions in patients with luminal and luminal infiltrated molecular subtypes compared with those with luminal papillary subtypes.

Disclosure: For full disclosures of the study authors, visit

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