Abstract
Simple SummaryUpper tract urothelial carcinoma (UTUC) is a rare malignancy that occurs mostly in elderly individuals with a high prevalence of comorbidities. However, the prognostic impact of comorbidities in these patients is not well evaluated. The aim of this retrospective study was to assess the significance of Adult Comorbidity Evaluation-27 (ACE-27) grade on the clinical outcomes of 409 patients with non-metastatic UTUC who underwent radical nephroureterectomy. We found that a high ACE-27 grade was an independent risk factor for UTUC progression, UTUC-specific death, and all-cause mortality in multivariate analyses. A prognostic model combining ACE-27 grade, tumor stage, and tumor grade showed good predictive performance and accuracy. Integrating the ACE-27 grade with standard pathological features can help physicians in clinical decision-making and risk stratification.Patients with upper tract urothelial carcinoma (UTUC) have a high prevalence of comorbidities. However, the prognostic impact of comorbidities in these patients is not well studied. We aimed to outline the comorbidity burden in UTUC patients and investigate its relationship with overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). We retrospectively reviewed the clinicopathological data of 409 non-metastatic UTUC patients who received radical nephroureterectomy between 2000 and 2015. The comorbidity burden was evaluated using the Adult Comorbidity Evaluation-27 (ACE-27). Kaplan-Meier survival analysis showed that high ACE-27 grade was significantly associated with worse PFS, CSS, and OS. In multivariate Cox regression and competing risk analyses, we found that ACE-27 grade, tumor stage, and tumor grade were independent prognosticators of OS, CSS, and PFS. We combined these three significant factors to construct a prognostic model for predicting clinical outcomes. A receiver operating characteristic curve revealed that our prognostic model had high predictive performance. The Harrel’s concordance indices of this model for predicting OS, CSS, and PFS were 0.81, 0.85, and 0.85, respectively. The results suggest that the UTUC patient comorbidity burden (ACE-27) provides information on the risk for meaningful clinical outcomes of OS, CSS, and PFS.
Highlights
Upper tract urothelial carcinoma (UTUC) is a rare but potentially lethal malignancy that accounts for about 5% of urothelial cancers and 10% of all renal tumors [1–3]
We retrospectively reviewed the charts of 495 patients who were diagnosed with upper tract urothelial carcinoma (UTUC)
80% of the patients were diagnosed with a high-grade disorder
Summary
Upper tract urothelial carcinoma (UTUC) is a rare but potentially lethal malignancy that accounts for about 5% of urothelial cancers and 10% of all renal tumors [1–3]. Radical nephroureterectomy (RNU) with the bladder cuff excision is the standard procedure for UTUC, despite the tumor location in the upper urinary tract [2–4]. Despite the refinement of the surgical and medical management of UTUC, patient outcomes have not changed significantly over the past few decades [8,9]. Comorbidity is defined as any coexisting condition or disease that can affect the diagnosis, treatment, and prognosis of an index disease under study [10,11]. It is an important independent prognostic factor in patients with cancer [12–14]. Correlations between the severity of comorbidities and clinical outcomes have been found among patients with colorectal cancer [15,16], breast cancer [16,17], prostate cancer [18,19], and bladder cancer [20]
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