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: 3.13). 05/2012; 110(11C). DOI: 10.1111/j.1464-410X.2012.11195.x
Source: PubMed

ABSTRACT 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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    ABSTRACT: The incidence of early stage renal cell carcinoma (RCC) is increasing and observational studies have shown equivalent oncological outcomes of partial versus radical nephrectomy for stage I tumours. Population studies suggest that compared with radical nephrectomy, partial nephrectomy is associated with decreased mortality and a lower rate of postoperative decline in kidney function. However, rates of chronic kidney disease (CKD) in patients who have undergone nephrectomy might be higher than in the general population. The risks of new-onset or accelerated CKD and worsened survival after nephrectomy might be linked, as kidney insufficiency is a risk factor for cardiovascular disease and mortality. Nephron-sparing approaches have, therefore, been proposed as the standard of care for patients with type 1a tumours and as a viable option for those with type 1b tumours. However, prospective data on the incidence of de novo and accelerated CKD after cancer nephrectomy is lacking, and the only randomized trial to date was closed prematurely. Intrinsic abnormalities in non-neoplastic kidney parenchyma and comorbid conditions (including diabetes mellitus and hypertension) might increase the risks of CKD and RCC. More research is needed to better understand the risk of CKD post-nephrectomy, to develop and validate predictive scores for risk-stratification, and to optimize patient management.
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    ABSTRACT: Objective To evaluate the impact of ‘hereditary-like’ status in upper tract urothelial carcinoma (UTUC) on the survival of patients who have undergone radical nephroureterectomy (RNU) and adjuvant chemotherapy.Patients and MethodsA multicentre retrospective study was performed on all patients with high-risk UTUC who underwent RNU and adjuvant cisplatin-based chemotherapy.Using a patient risk identification tool, we distinguished tumours suspected to be hereditary from sporadic tumours and compared survival rates.ResultsA total of 112 patients with a median age of 67 years were included. Hereditary-like tumour status was detected in 35 patients (31.3%), while 77 patients (68.7%) had sporadic tumours.The median age was significantly younger in the hereditary-like tumour group (56.0 vs 69.8 years, P < 0.001). Overall survival (OS) after chemotherapy was significantly better in the group with hereditary-like tumours than in the group with sporadic tumours (5-year OS: 48.2 vs 32%; P = 0.008).The cancer-specific survival (CSS) rate was significantly better in the group with ‘hereditary-like’ tumours than in the group with sporadic tumours (5-year CSS: 58 vs 35%; P = 0.006).Although there was a trend in favour of the hereditary-like tumours, we observed no significant difference regarding progression-free survival (PFS) between the two groups (5-year PFS: 71 vs 52%; P = 0.07).Conclusion Adjuvant chemotherapy after RNU improves survival outcomes in patients with hereditary-like UTUC compared with those with sporadic tumours.
    BJU International 04/2014; 113(4). DOI:10.1111/bju.12308 · 3.13 Impact Factor
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    ABSTRACT: ● To evaluate the prognostic value of the Bajorin criteria in a multi-institutional cohort of patients with disease recurrence (dRec) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). ● We further investigated whether clinical, pathologic, and/or biological factors at time of dRec are also associated with cancer-specific outcomes in these patients. ● We identified 242 patients with dRec after RNU for UTUC from eleven centers. ● In regards to the Bajorin criteria, patients were categorized into three groups based on two risk factors: Karnofsky performance status <80% and presence of visceral metastasis. ● Assessed variables included pathologic characteristics, time to dRec, age-adjusted Charlson comorbidity index (ACCI), ASA score, and laboratory tests at time of dRec. ● Overall, 185 patients died of disease; median survival was 9 months. Survival at one year was 53%, 33%, and 39% for patients with no (n=18), one (n=109), and two (n=115) risk factors, respectively, with no significant difference between the groups. ● In univariable analyses, higher pT-stage, tumor necrosis, non-administered salvage chemotherapy, higher ACCI, higher ASA score, lower albumin level and higher white blood cell count were significantly associated with a shorter time to cancer-specific mortality. ● We confirmed the poor yet variable outcomes of patients with dRec after RNU. ● While the Bajorin criteria seem to have limited prognostic value in this specific cohort, we found several other clinical variables to be associated with worse cancer-specific mortality. ● If validated, these factors should be taken into consideration for clinical trial design.
    BJU International 07/2013; 113(6). DOI:10.1111/bju.12369 · 3.13 Impact Factor


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