Abstract
IntroductionAs a research team of urologists and an anesthetist, we sought to investigate the prognostic significance of American Society of Anesthesiologists (ASA) score in patients with upper tract urothelial cancer (UTUC) after radical nephroureterectomy (RNU). ASA physical status (ASA-PS) classification not only was found to be associated with increased comorbidities but also independently factors for predicting morbidity and mortality. Accurate risk assessment was being particularly important for patients being considered for surgery.MethodsRecords for 958 patients with UTUC who underwent RNU were reviewed. Clinicopathologic variables, including ASA-PS, were assessed at two institutions. Overall survival (OS), cancer-specific survival (CSS), intravesical recurrence-free survival (IRFS), and metastasis-free survival (MFS) were estimated using the Kaplan–Meier method and Cox regression analyses. We measured the independent predictive value of ASA-PS for mortality by multivariate regression. Association of ASA-PS and clinicopathologic variables was assessed.ResultsThe group of patients with ASA = 2/3 had a shorter 5-year OS (67.6% and 49.9%), CSS (72.9% and 58.1%), and MFS (75.1% and 58.5%). The median follow-up time was 39 months. Kaplan–Meier curves showed that the group with ASA = 2/3 had significantly poorer OS, CSS, and MFS. Adjusting for multiple potential confounding factors, multivariate analyses suggested that ASA score was an independent predictor of OS, CSS, and MFS (p = 0.004, p = 0.005, p < 0.001).ConclusionHigher ASA scores were independently associated with lower survival rate. This capability, along with its simplicity, makes it a valuable prognostic metric. It should be seriously referenced in UTUC patients being considered for RNU.
Highlights
As a research team of urologists and an anesthetist, we sought to investigate the prognostic significance of American Society of Anesthesiologists (ASA) score in patients with upper tract urothelial cancer (UTUC) after radical nephroureterectomy (RNU)
Radical nephroureterectomy (RNU) with bladder cuff excision is considered the gold standard for the treatment of upper tract urothelial cancer (UTUC), distant relapses are common for locally advanced high-grade disease
196 patients received adjuvant chemotherapy (AC), including 53 pTa-1 patients and 143 pT2– 4 patients. As to these 53 pTa-1 patients, we found most of them had the presence of risk factors, including positive lymph node, high tumor grade, tumor size >3 cm, and flat architecture
Summary
As a research team of urologists and an anesthetist, we sought to investigate the prognostic significance of American Society of Anesthesiologists (ASA) score in patients with upper tract urothelial cancer (UTUC) after radical nephroureterectomy (RNU). Radical nephroureterectomy (RNU) with bladder cuff excision is considered the gold standard for the treatment of upper tract urothelial cancer (UTUC), distant relapses are common for locally advanced high-grade disease. UTUC is the most aggressive malignant tumor of the urinary system [1]; 30% of patients demonstrate invasive and/or locally advanced disease, 30%–40% have regional lymph node (LN) involvement, and 20% have metastatic disease [2, 3]. For UTUC patients, pathological stage, tumor grade, lymph node metastasis, and tumor multifocality are known to be wellestablished prognostic factors [6,7,8]. Potential prognostic preoperative factors would benefit outcome prediction and individual patient treatment choices
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