PURPOSE: To assess the association of patient age with response to preoperative chemotherapy in patients with muscle-invasive bladder cancer (MIBC). MATERIALS AND METHODS: We analyzed data from 1105 patients with MIBC. Patients age was evaluated as continuous variable and stratified in quartiles. Pathologic objective response (pOR; ypT0-Ta-Tis-T1N0) and pathologic complete response (pCR; ypT0N0), as well survival outcomes were assessed. We used data of 395 patients from The Cancer Genome Atlas (TCGA) to investigate the prevalence of TCGA molecular subtypes and DNA damage repair (DDR) gene alterations according to patient age. RESULTS: pOR was achieved in 40% of patients. There was no difference in distribution of pOR or pCR between age quartiles. On univariable logistic regression analysis, patient age was not associated with pOR or pCR when evaluated as continuous variables or stratified in quartiles (all p > 0.3). Median follow-up was 18 months (IQR 6-37). On Cox regression and competing risk regression analyses, age was not associated with survival outcomes (all p > 0.05). In the TCGA cohort, patient with age ≤ 60 years has 7% less DDR gene mutations (p = 0.59). We found higher age distribution in patients with luminal (p < 0.001) and luminal infiltrated (p = 0.002) compared to those with luminal papillary subtype. CONCLUSIONS: While younger patients may have less mutational tumor burden, our analysis failed to show an association of age with response to preoperative chemotherapy or survival outcomes. Therefore, the use of preoperative chemotherapy should be considered regardless of patient age.

Bristol Urological Institute North Bristol NHS Trust Bristol UK

Cross Cancer Institute Edmonton AB Canada

Department of Genitourinary Oncology H Lee Moffitt Cancer Center and Research Institute Tampa FL USA

Department of Hematology and Medical Oncology Taussig Cancer Institute Cleveland Clinic Cleveland USA

Department of Medicine Division of Medical Oncology University of Washington School of Medicine and Fred Hutchinson Cancer Research Center Seattle WA USA

Department of Oncology University of Alberta Edmonton AB Canada

Department of Surgery Exeter Surgical Health Services Research Unit Royal Devon and Exeter NHS Trust Exeter UK

Department of Surgery McGill University Health Center Montreal Canada

Department of Urologic Sciences University of British Columbia Vancouver BC Canada

Department of Urologic Surgery Vanderbilt University Medical Center Nashville TN USA

Department of Urology 2nd Faculty of Medicine Charles University Prag Czech Republic

Department of Urology Comprehensive Cancer Center Medical University of Vienna Währinger Gürtel 18 20 1090 Vienna Austria

Department of Urology Davis Medical Center University of California At Davis Sacramento CA USA

Department of Urology Freeman Hospital Newcastle Upon Tyne UK

Department of Urology Fundacion Instituto Valenciano de Oncologia Valencia Spain

Department of Urology Hôpital Bichat Claude Bernard Assistance Publique Hôpitaux de Paris Université de Paris Paris France

Department of Urology MD Anderson Cancer Center Houston TX USA

Department of Urology Molinette Hospital University of Turin Turin Italy

Department of Urology Stanford University School of Medicine Stanford CA USA

Department of Urology The James Buchanan Brady Urological Institute The Johns Hopkins School of Medicine Baltimore MD USA

Department of Urology The Netherlands Cancer Institute Antoni Van Leeuwenhoek Hospital Amsterdam The Netherlands

Department of Urology University of Kansas Medical Center Kansas City KS USA

Department of Urology University of Michigan Health System Ann Arbor MI USA

Department of Urology University of Münster Münster Germany

Department of Urology University of Oklahoma College of Medicine Oklahoma City OK USA

Department of Urology University of Texas Southwestern Medical Center Dallas TX USA

Department of Urology University of Washington Seattle WA USA

Department of Urology Western Health Melbourne Australia

Departments of Urology Weill Cornell Medical College New York NY USA

Glickman Urological and Kidney Institute Cleveland Clinic Cleveland OH USA

Hertfordshire and Bedfordshire Urological Cancer Centre Department of Urology Lister Hospital Stevenage UK

Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Princess Margaret Hospital Toronto ON Canada

University of Alberta Edmonton AB Canada

University of Auckland Auckland New Zealand

USC Norris Comprehensive Cancer Center Institute of Urology University of Southern California Los Angeles CA USA

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