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TALL score for prediction of oncological outcomes after radical nephroureterectomy for high-grade upper tract urothelial carcinoma

  • Original Article
  • Published:
World Journal of Urology Aims and scope

Abstract

Purpose

We created a prognostic tool for the prediction of oncologic outcomes after radical nephroureterectomy (RNU) for high-grade non-metastatic upper tract urothelial carcinoma (UTUC).

Methods

UTUC collaboration was utilized to include 586 patients who underwent RNU for non-metastatic high-grade UTUC. Survival outcomes were compared according to a score defined based on the sum of the independent prognostic variables.

Results

The study included 382 males with a median age 70 years (range 28–97). Independent prognostic factors included: T (t stage), A (architecture), LVI (lympho-vascular invasion) and L (lymphadenectomy). TALL score (1–7) was the sum of T (≤T1 = 1, T2 = 2, T3 = 3 and T4 = 4), A (papillary = 0 and sessile = 1), LVI (absent = 0 and present = 1) and L (lymphadenectomy = 0 and no lymphadenectomy = 1). Five-year disease-free survival (DFS) and cancer-specific survival (CSS) were stratified into four risk categories according to the TALL score: low (TALL 0–2; 86 % DFS and 90 % CSS), intermediate (TALL = 3; 71 % DFS and 75 % CSS), high (TALL = 4; 57 % DFS and 58 % CSS) and very high risk (TALL ≥ 5; 34 % DFS and 38 % CSS) using Kaplan–Meier survival analyses. TALL score was externally validated in a single-center cohort of 85 UTUC patients.

Conclusions

We developed a multivariable prognostic tool for the prediction of oncological outcomes after RNU for high-grade UTUC. The score can be used for patient counseling, selection for adjuvant systemic therapies and design of clinical trials.

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Abbreviations

RNU:

Radical nephroureterectomy

UTUC:

Upper tract urothelial carcinoma

TALL:

T (t stage), A (architecture), LVI (lympho-vascular invasion) and L (lymphadenectomy)

DFS:

Disease-free survival

CSS:

Cancer-specific survival

AJCC/UICC:

American Joint Cancer Committee/Union Internationale Contre le Cancer

WHO/ISUP:

World Health Organization/International Society of Urologic Pathology

LN:

Lymph nodes

CIS:

Carcinoma in situ

ROC:

Receiver operating characteristic

HR:

Hazard ratio

CI:

Confidence interval

UCB:

Urothelial carcinoma of the bladder

N0:

Node negative

Nx:

Unknown nodal status

M0:

No metastasis

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Conflict of interest

There were no conflicts of interest to any of the authors with the content of the manuscript.

Ethical standard

The study followed all known ethics of research. The contents of this manuscript have not been copyrighted or published previously, are not under consideration for publication elsewhere and will not be copyrighted, submitted or published elsewhere while acceptance by the Journal is under consideration.

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Authors and Affiliations

  1. University of California, Irvine, Orange, CA, USA

    Ramy F. Youssef

  2. University of Muenster Medical Center, Muenster, Germany

    Laura-Maria Krabbe

  3. Vienna General Hospital, Medical University of Vienna, Vienna, Austria

    Shahrokh F. Shariat

  4. UT Southwestern Medical Center, Dallas, TX, USA

    Yair Lotan, Arthur I. Sagalowsky & Vitaly Margulis

  5. Penn State Milton S. Hershey Medical Center, Hershey, PA, USA

    Jay Raman

  6. UT M.D. Anderson Cancer Center, Houston, TX, USA

    Christopher G. Wood

  7. University of Michigan, Ann Arbor, MI, USA

    Alon Weizer

  8. AO Papa Giovanni XXIII, Bergamo, Italy

    Marco Roscigno

  9. Vita Salute University, San Raffaele, Milan, Italy

    Francesco Montorsi

  10. Mannheim Medical Center, University of Heidelberg, Mannheim, Germany

    Christian Bolenz

  11. Landesklinikum Korneuburg, Korneuburg, Austria

    Mesut Remzi

  12. Bicêtre University Hospital, Le Kremlin Bicêtre, France

    Karim Bensalah

  13. McGill University Health Center, Montreal, QC, Canada

    Wassim Kassouf

Authors
  1. Ramy F. Youssef
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  2. Laura-Maria Krabbe
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  3. Shahrokh F. Shariat
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  4. Yair Lotan
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  5. Arthur I. Sagalowsky
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  6. Jay Raman
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  7. Christopher G. Wood
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  8. Alon Weizer
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  9. Marco Roscigno
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  10. Francesco Montorsi
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  11. Christian Bolenz
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  12. Mesut Remzi
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  13. Karim Bensalah
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  14. Wassim Kassouf
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  15. Vitaly Margulis
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Corresponding author

Correspondence to Vitaly Margulis.

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Youssef, R.F., Krabbe, LM., Shariat, S.F. et al. TALL score for prediction of oncological outcomes after radical nephroureterectomy for high-grade upper tract urothelial carcinoma. World J Urol 33, 1965–1972 (2015). https://doi.org/10.1007/s00345-015-1566-8

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  • DOI: https://doi.org/10.1007/s00345-015-1566-8

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