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The role of American Society of Anesthesiologists scores in predicting urothelial carcinoma of the upper urinary tract outcome after radical nephroureterectomy: results from a national multi-institutional collaborative study.

Berod Academic Department of Urology, CHRU Grenoble, University of Grenoble, Grenoble Academic Department of Urology, CHU Lille, Lille Nord de France University, Lille Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI Department of Urology, Institut Mutualiste Montsouris Department of Urology, Val de Grâce Military Hospital Géraldine Pignot Academic Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, René Descartes University, Paris Academic Department of Urology, Edouard Herriot Hospital, Claude Bernard Lyon 1 University Academic Department of Urology, Lyon Sud Hospital, Claude Bernard Lyon 1 University, Lyon Academic Department of Urology, CHU Marseille, University of Marseille, Marseille Academic Department of Urology, CHRU Reims, University of Reims, Reims Academic Department of Urology, CHRU Angers, University of Angers, Angers Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse Academic Department of Urology, CHRU Clermont-Ferrand, University of Clermont-Ferrand, Clermont-Ferrand Academic Department of Urology, CHRU Limoges, University of Limoges, Limoges Academic Department of Urology, CHRU Nîmes, University of Nimes, Nimes Department of Urology, Foch Hospital, University of Paris-Ile de France Ouest, Suresnes Academic Department of Urology, CHRU Brest, University of Brest, Brest Academic Department of Urology, CHRU Poitiers, University of Poitiers, Poitiers, France.
BJU International (Impact Factor: 3.05). 05/2012; DOI: 10.1111/j.1464-410X.2012.11195.x
Source: PubMed

ABSTRACT Study Type - Prognosis (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Upper urinary tract urothelial carcinoma (UUT-UC) is a rare disease, usually treated by nephroureterectomy, occurring in a population with a median age of 70 years and with frequent tobacco use and other comorbidities. We know that the American Society of Anesthesiologists (ASA) score has prognostic value in urological oncology but this has not been assessed in UUT-UC. Using a multi-institutional French database, we have shown that the 5-year cancer-specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P= 0.01). ASA status had a significant impact on cancer-specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients (P= 0.04). OBJECTIVE: •  To evaluate the impact of American Society of Anesthesiologists (ASA) scores on the survival of patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UUT-UC). PATIENTS AND METHODS: •  A retrospective multi-institutional cohort study of the French collaborative national database of UUT-UC treated by RNU in 20 centres from 1995 to 2010. •  The influence of age, gender and ASA score on survival was assessed using a univariable and multivariable Cox regression analysis with pathological features used as covariables. RESULTS: •  Overall, 554 patients were included. The median follow-up was 26 months (10-48 months), and the median age was 69.5 years (61-76 years). In total, 114 (20.6%) patients were classified as ASA 1, 326 (58.8%) as ASA 2 and 114 (20.6%) as ASA 3. •  The 5-year recurrence-free survival (P= 0.21) and metastasis-free survival (P= 0.22) were not significantly different between ASA 1 (52.8% and 76%), ASA 2 (51.9% and 75.3%) and ASA 3 patients (44.1% and 68.2%, respectively). •  The 5-year cancer-specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P= 0.01). •  ASA status had a significant impact on cancer-specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients (P= 0.04). CONCLUSIONS: •  ASA classification correlates significantly with cancer-specific survival after RNU for UUT-UC. •  It is a further pre-operative clinical variable that can be incorporated into future risk prediction tools for UUT-UC to improve their accuracy.

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