Chronological and biological age stratify survival after robot-assisted radical cystectomy for bladder cancer: a pragmatic age-ECOG risk score

Puntos clave

• The study aims to evaluate the impact of chronological and biological age on survival outcomes in patients undergoing robot-assisted radical cystectomy for bladder cancer.
• Retrospective analysis of consecutive patients who underwent robot-assisted radical cystectomy from August 2013 to December 2024.
• Patients were stratified by age into four groups: <75, 75–79, 80–84, and ≥85 years.
• Complications were graded using the Clavien–Dindo classification after the procedure.
• Overall survival was estimated using Kaplan–Meier methods, with optimal age thresholds determined by receiver operating characteristic analysis.
• A risk score was developed based on age and ECOG performance status.
• Overall survival significantly differed by age cohort (p = 0.00013) with an optimal age threshold identified at 76.5 years (p < 0.0001).
• ECOG performance status ≥ 2 was a strong predictor of worse survival (p < 0.0001).
• The developed risk score effectively differentiated survival outcomes among different score groups (p < 0.0001).
• Multivariable analysis showed age > 76.5 years is independently associated with worse overall survival (hazard ratio 2.72, 95% CI 1.58–4.68; p < 0.001).