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Radical nephroureterectomy for UTUC conferred survival benefits irrespective of age and comorbidities

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Abstract

Purpose

We investigated the effects of age, American Society of Anesthesiologists Physical Status Classification (ASA) grading and Charlson Comorbidity Index (CCI) on the survival outcomes of upper tract urothelial carcinoma (UTUC).

Methods

The CROES-UTUC registry was an international, multicenter study on patients with UTUC. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Kaplan–Meier and multivariate Cox regression analyses were performed by stratifying patients according to their age (≤ 70 and > 70 years old) and ASA grade (I–II and III–V)/CCI (0–1 and ≥ 2).

Results

A total of 2352 patients were included in this study. Patients aged ≤ 70 years with ASA grading of I–II (p = 0.002), and patients aged ≤ 70 years with a CCI of 0–1 (p = 0.002) had the best OS. Upon multivariate analysis, both in patients aged ≤ 70 and > 70 years, ASA grading and CCI were not significantly associated with OS. Patients aged ≤ 70 years with ASA grading of III–IV (p = 0.024) had the best DFS. When stratified according to age and CCI, no significant difference in DFS was noted. Upon multivariate analysis, radical nephroureterectomy (RNU) was significantly associated with better DFS in patients aged ≤ 70 and > 70 years; CCI of ≥ 3 was significantly associated with worse DFS in patients ≤ 70 years; ASA grading was not associated with DFS in patients aged ≤ 70 and > 70 years.

Conclusions

A high ASA grading and CCI should not be considered contraindications for RNU. RNU should be considered even in elderly patients when it is deemed feasible and achievable after a geriatric assessment.

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Abbreviations

ASA:

American Society of Anesthesiologists Physical Status Classification

CCI:

Charlson Comorbidity Index

CROES-UTUC:

Clinical Research Office of the Endourology Society Urothelial Carcinomas of the Upper Tract

RNU:

Radical nephroureterectomy

UTUC:

Upper tract urothelial carcinoma

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Acknowledgements

We would like to thank Rachel Mbassa (Statistician/Data Research Manager) and Sonja van Rees-Vellinga (Executive Director CROES) for their collaboration and support.

Funding

This work is supported by an unrestricted educational grant from STORZ to the Clinical Research Office of the Endourology Society (CROES).

Author information

Authors and Affiliations

  1. S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China

    Jeremy Yuen-Chun Teoh & Chi-Fai Ng

  2. Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Masatoshi Eto

  3. Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India

    Mallikarjuna Chiruvella

  4. Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy

    Umberto Capitanio

  5. Department of Urology, Koc University Hospital, Istanbul, Turkey

    Tarik Esen

  6. Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

    Guohua Zeng

  7. Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France

    Eric Lechevallier

  8. Division of Urology, McGill University, Montreal, QC, Canada

    Sero Andonian

  9. Department of Urology, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey

    Jean de la Rosette

Authors
  1. Jeremy Yuen-Chun Teoh
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Contributions

All authors contributed to study conception, design, data analysis and interpretation, reviewed and approved the final content of this manuscript.

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Correspondence to Jeremy Yuen-Chun Teoh.

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Teoh, J.YC., Ng, CF., Eto, M. et al. Radical nephroureterectomy for UTUC conferred survival benefits irrespective of age and comorbidities. World J Urol 40, 2657–2665 (2022). https://doi.org/10.1007/s00345-022-04152-7

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