Bladder cancer in patients younger than 40 years: outcomes from the National Cancer Database

Comparative Analysis of Clinicopathologic Characteristics and Outcomes of Urothelial Bladder Cancer Between Young and Older Adults-Experience from a Tertiary Care Center

The evidence on bladder cancer in the young population remains fragmented due to lack of literature and conflicting results from the existing studies. We aim to elucidate such conflicting data and define the clinicopathologic characteristics, management trends, and outcomes of urothelial bladder carcinoma in young adults as compared to their older counterparts. This was a retrospective, single-center study involving patients with primary urothelial bladder cancer who underwent treatment at our center from March 2017 to March 2022. For analysis, patients were stratified into three subgroups based on age: group A, 18-40 years; group B, > 40 years; and group C, > 60 years. Group A with younger patients was compared with groups B and C. A total of 471 eligible patients (422 males and 49 females) were included in the study with a median age of 44 years. Group A had significantly lower recurrence and progression rates as compared to group B (31% vs 57.1%, p = 0.002 and 9.5% vs 19.2%, p = 0.04, respectively). Group A had significantly more recurrence-free survival (RFS) than group B (5-year-RFS = 68.03% vs 32.58%, p = 0.01). Similarly, group A also had lower recurrence (31% vs 62.6%, p < 0.001) and progression (9.5% vs 28.6%, p = 0.015) rates as compared to group C as well as better RFS (5-year-RFS = 68.03% vs 19.00%, p = 0.04) and progression-free survival (5-year-PFS = 83.1% vs 62.8%, p = 0.03) in comparison to group C. Age and tumor grade were found to be independent predictors of recurrence-free and progression-free survival. We concluded that high-grade disease is more common than low-grade disease both in younger and older patients. Younger patients fare better in terms of recurrence and progression when compared to their older counterparts.

A Clinicopathological Correlation of Bladder Cancer in Young and Old Patients: Our Experience and Review of Literature

To compare the clinical, cystoscopic, and pathological characteristics of bladder cancer in patients younger than 40 years of age and those of patients older than 40 years of age. We conducted a prospective observational study at our department from September 2019 to February 2021 to compare the clinico-pathological characteristics of young and old patients with biopsy proven bladder cancer after a transurethral resection of bladder tumour. The patients were managed according to standard guidelines. Two hundred sixty-eight patients of bladder cancer were included in the analysis. Out of these, 58 patients were < 40 years of age and 210 were > 40 years. The mean age of two groups were 31.43 ± 6.30 vs 59.08 ± 9.87 years. With respect to tumour grade, 36.2% (versus 17.6%) of young patients had low grade tumour, and 58.6% had high-grade tumour (versus 82.4%). In the young population, 63.8% patients had NMIBC (versus 61.9%) and 36.2% had MIBC (versus 38.1%). Even in the NMIBC group, a large majority of young patients had high-risk disease (51.4%). The incidence of bladder cancer is on the rise in the northern belt of India, especially in the younger age group. High exposure to smoke and heavy metals in drinking water/occupation are the major risk factors. Majority of young patients aged < 40 years had a high-grade disease on presentation and a large subset had muscle invasive bladder cancer, contrary to previously reported studies.

Risk of bladder cancer death in patients younger than 50 with non-muscle-invasive and muscle-invasive bladder cancer

INTRODUCTION AND OBJECTIVES

Bladder cancer is primarily a disease of older age and little is known about the differences between patients diagnosed with bladder cancer at a younger versus older age. Our objectives were to compare bladder cancer specific survival in patients aged <50 versus those aged 50-70 at time of diagnosis.

MATERIALS AND METHODS

The Swedish bladder cancer database provided data on patient demographics, clinical characteristics and treatments for this observational study. Cox proportional hazard regression models were adjusted for appropriate variables. All analyses were stratified by disease stage (non-muscle-invasive bladder cancer and muscle-invasive bladder cancer. Furthermore, we compared the frequency of lower urinary tract infections within 24 months prior to bladder cancer diagnosis by sex and age groups.

RESULTS

The study included 15,452 newly-diagnosed BC patients (1997-2014); 1,207 (8%) patients were <50 whilst 14,245 (92%) were aged 50-70. Patients aged <50 at diagnosis were at a decreased risk of bladder cancer death (HR = 0.82, 95%CI: 0.68-0.99) compared to those aged 50-70. When stratified by non-muscle-invasive and muscle-invasive bladder cancer, this association remained in non-muscle-invasive patients only (<50, HR = 0.43, 95% CI: 0.28-0.64). The frequency of lower urinary tract infection diagnoses did not differ between younger and older patients in either men or women.

CONCLUSIONS

Patients diagnosed with non-muscle-invasive bladder cancer when aged <50 are at decreased risk of bladder cancer-specific death when compared to their older (50-70) counterparts. These observations raise relevant research questions about age-related differences in diagnostic procedures, clinical decision-making and, not least, potential differences in tumour biology.

Young age increases the risk of lymph node positivity but improves prognosis in patients with bladder cancer treated via cystectomy: a population-based study

BACKGROUND

Age and lymph node positivity are significant prognostic indicators in patients with bladder cancer. This study aimed to investigate the impact of age on lymph node positivity and bladder cancer outcomes.

METHODS

Patients with bladder cancer who underwent cystectomy with at least one lymph node examined between 2004 and 2015 were identified from the Surveillance, Epidemiology, and End Results database. Cochran-Armitage trend tests and logistic regression analyses were used to evaluate the association between age and lymph node positivity in all T stages. Multivariate Cox regression analysis was used to analyze the effect of age on overall survival (OS) and cancer-specific survival (CSS).

RESULTS

Overall, 13,251 patients were identified, 648 of whom were under 50 years of age (4.89%). Lymph node positivity was negatively associated with increasing age in each stage except in non-invasive-muscular bladder cancer. In the multivariable analysis, age was an independent prognostic factor for OS and CSS in both the overall cohort and the lymph node positivity group.

CONCLUSIONS

In patients with bladder cancer undergoing cystectomy, young age at diagnosis is associated with a higher risk of lymph node positivity and superior outcomes. These findings may guide clinicians in selecting suitable treatments, determining the aggressiveness of lymph node involvement, and predicting survival outcomes in patients of different ages.