Age-stratified outcomes of radical cystectomy for muscle-invasive bladder cancer: a nationwide multicenter study of 1867 patients in Japan

Background Radical cystectomy (RC) remains the standard treatment for muscle-invasive bladder cancer (MIBC), but is highly invasive and may cause functional decline, especially among geriatric patients. This study evaluated age-stratified outcomes of RC through a nationwide, multi-institutional cohort in Japan. Methods We analyzed 1867 patients with MIBC who underwent RC at 36 institutions, stratified into five age groups: <60, 60–69, 70–74, 75–79, and ≥80 years. The baseline characteristics, perioperative factors, and oncological outcomes were compared. Results Patients aged ≥80 years had significantly worse overall survival (OS, P < .001), cancer-specific survival (CSS, P = .006), and disease-free survival (DFS, P = .004) after RC. Although preoperative clinical T stage was comparable (P = .22), patients aged ≥80 years less frequently received neoadjuvant chemotherapy (NAC), and more often showed pathological extravesical extension and positive surgical margins (all P < .001). The incidence of grade ≥3 complications and 30-day mortality were comparable, whereas 90-day mortality was higher in this group (P = .047). Multivariable Cox analysis confirmed age ≥80 years as an independent predictor for unfavorable OS (P < .001), CSS (P = .017), and DFS (P = .018). Among patients aged ≥80 years, the use of NAC was associated with better OS (P = .033), particularly in those with Eastern Cooperative Oncology Group performance status of 0 (P = .015). Conclusion Patients aged ≥80 years had significantly worse oncological outcomes after RC. NAC may improve OS in selected older patients with good performance status.