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: 3.53). 05/2012; 110(11C). DOI: 10.1111/j.1464-410X.2012.11195.x
Source: PubMed


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).

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    ABSTRACT: CONTEXT: The European Association of Urology (EAU) guideline group for upper tract urothelial carcinoma (UTUC) has prepared updated guidelines to aid clinicians in assessing the current evidence-based management of UTUC and to incorporate present recommendations into daily clinical practice. OBJECTIVE: To provide a brief overview of the EAU guidelines on UTUC as an aid to clinicians in their daily clinical practice. EVIDENCE ACQUISITION: The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified using a systematic search of Medline. Data on urothelial malignancies and UTUCs in the literature were searched using Medline with the following keywords: urinary tract cancer; urothelial carcinomas; upper urinary tract, carcinoma; renal pelvis; ureter; bladder cancer; chemotherapy; nephroureterectomy; adjuvant treatment; instillation; neoadjuvant treatment; recurrence; risk factors; nomogram; and survival. References were weighted by a panel of experts. EVIDENCE SYNTHESIS: There is a lack of data in the current literature to provide strong recommendations (ie, grade A) due to the rarity of the disease. A number of recent multicentre studies are now available, and there is a growing interest in UTUC in the recent literature. Overall, 135 references have been included here, but most of these studies are still retrospective analyses. The TNM 2009 classification is recommended. Recommendations are given for diagnosis as well as radical and conservative treatment (ie, imperative and elective cases); additionally, prognostic factors are discussed. Recommendations are also provided for patient follow-up after different therapeutic options. CONCLUSIONS: These guidelines contain information for the management of individual patients according to a current standardised approach. Physicians must take into account the specific clinical characteristics of each individual patient when determining the optimal treatment regimen including tumour location, grade, and stage; renal function; molecular marker status; and medical comorbidities.
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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.
    Full-text · Article · Jul 2013 · BJU International
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    ABSTRACT: Introduction Upper urinary tract urothelial carcinoma (UTUC) is a rare disease. Thus, little evidence-based data are available to guide clinical decision-making. The aim of the study was to provide an overview of the currently available prognostic factors for UTUC. Material and methods A systematic literature search was conducted using the PubMed databases to identify original articles regarding prognostic factors in patients with UTUC. Results We divided the prognostic factors for UTUC in four different categories: clinical factors, preoperative characteristics, intraoperative/surgical factors and postoperative/pathologic factors. Prognostic factors described in order of importance are: tumor stage and grade, lymph node involvement, a concomitant cis, age at the diagnostic, lymphovascular invasion, tumor architecture and necrosis, tumor location and multifocality, gender. The impact of obesity, smoking and other comorbidities (ECOG, ASA) on outcomes has been recently reported but needs to be validated. The endoscopic approach of distal ureter management during radical nephroureterectomy has been shown to be at higher risk of bladder recurrence. Conclusion The incorporation of such prognosticators into clinical prediction models might help to guide decision-making with regard to timing of surveillance, type of treatment, performance of lymphadenectomy, and consideration of neoadjuvant or adjuvant systemic therapies.
    No preview · Article · Dec 2013 · Progrès en Urologie
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