{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T05:19:08Z","timestamp":1740979148123,"version":"3.38.0"},"reference-count":26,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T00:00:00Z","timestamp":1721952000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Urologia"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p> There is interest in using bladder-preserving therapy as an alternative definitive therapy for muscle invasive bladder cancer in certain high-risk groups such as the elderly. <\/jats:p><\/jats:sec><jats:sec><jats:title>Objective:<\/jats:title><jats:p> To determine if bladder-preserving therapy represents a safer alternative to surgical intervention in elderly patients with muscle invasive bladder cancer. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p> We surveyed the Surveillance, Epidemiology and End Results database (SEER) for cases of non-metastasized malignant bladder cancer in patients aged 80+. Survival outcomes with radical cystectomy (RC) with or without chemotherapy were compared to those after chemotherapy and radiation without cystectomy. We performed log-rank tests and Kaplan-Meier and cox regression and hazard analyses before and after propensity score matching. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> A total of 2995 patients were identified, with 49.98% treated with RC only, 8.65% treated with RC\/chemotherapy, and 41.37% treated with chemotherapy and radiation without RC. Median overall survival for the RC only, RC\/chemotherapy and chemotherapy\/radiation groups were 31.4, 44.1, and 24.6\u2009months, respectively. On multivariate analysis, hazard ratios (reference: RC\/chemotherapy group) were RC Only (HR\u2009=\u20091.408 (95% CI 1.188\u20131.669), p\u2009&lt;\u20090.0001) and chemotherapy\/radiation (HR\u2009=\u20091.650 (95% CI 1.390\u20131.959), p\u2009&lt;\u20090.0001). After matching the chemotherapy\/radiation and RC\/chemotherapy groups, the former continued to show survival hazard (HR\u2009=\u20091.744 (95% CI 1.414\u20132.155), p\u2009&lt;\u20090.0001). <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p> Octogenarians should be offered definitive local therapy for their localized bladder cancer including RC and chemotherapy. Bladder-sparing alternatives should be reserved for patients unfit for surgery. <\/jats:p><\/jats:sec>","DOI":"10.1177\/03915603241265828","type":"journal-article","created":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T13:15:43Z","timestamp":1721999743000},"page":"701-708","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing the safety of bladder-preserving therapy as an alternative to surgical intervention in elderly patients with muscle invasive bladder cancer"],"prefix":"10.1177","volume":"91","author":[{"given":"Christopher R.","family":"Koller","sequence":"first","affiliation":[{"name":"Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2544-4436","authenticated-orcid":false,"given":"Jacob W.","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caleb","family":"Natale","sequence":"additional","affiliation":[{"name":"Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. Spencer","family":"Krane","sequence":"additional","affiliation":[{"name":"Southeast Louisiana Veterans Health Care System, Department of Surgery, New Orleans, LA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,7,26]]},"reference":[{"key":"bibr1-03915603241265828","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21590"},{"key":"bibr2-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.1684"},{"key":"bibr3-03915603241265828","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21565"},{"key":"bibr4-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2011.12.038"},{"key":"bibr5-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30900"},{"key":"bibr6-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1097\/01.ju.0000093721.23249.c3"},{"key":"bibr7-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-8140(01)00455-8"},{"volume-title":"Sas\/stat\u00ae 14.2 user\u2019s guide","year":"2016","author":"SAS Institute Inc","key":"bibr8-03915603241265828"},{"key":"bibr9-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1080\/00273171.2011.568786"},{"key":"bibr10-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2017.22"},{"issue":"1","key":"bibr11-03915603241265828","first-page":"72","volume":"185","author":"Fedeli U","journal-title":"J Urol 2011"},{"key":"bibr12-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2006.08.026"},{"issue":"7","key":"bibr13-03915603241265828","first-page":"737","volume":"306","author":"Freedman N","journal-title":"JAMA 2011"},{"key":"bibr14-03915603241265828","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2017.0156"},{"key":"bibr15-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.57.5548"},{"key":"bibr16-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.07.211"},{"key":"bibr17-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2011.11.010"},{"key":"bibr18-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1016\/j.clgc.2018.09.023"},{"key":"bibr19-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctarc.2020.100177"},{"key":"bibr20-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20654"},{"key":"bibr21-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2012.08.009"},{"key":"bibr22-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2017.04.086"},{"key":"bibr23-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1016\/j.clgc.2019.06.010"},{"key":"bibr24-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2017.08.086"},{"key":"bibr25-03915603241265828","doi-asserted-by":"publisher","DOI":"10.1089\/end.2012.0606"},{"key":"bibr26-03915603241265828","unstructured":"Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov). 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