Abstract
Objective: To determine the prognostic value of the American Society of Anesthesiologists (ASA) classification and of the main clinical pathologic variables in renal cell carcinoma (RCC) patients who underwent surgical treatment. Methods: In this international collaborative study, 376 RCC patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) during the period 1989-2009 were assessed. The pathological data were reviewed by a single pathologist, and all of the surgically treated patients had been previously evaluated by a team of anesthesiologists and classified as ASA 1, ASA 2, or ASA 3. Results: In total, 318 patients were included in the study, with a mean followup of 48 months. Incidental tumors represented 47% of the cases, while 11.6% presented with metastases at diagnosis. Among the patients assessed, 38 (11.9%) were classified as ASA 1, 213 (67%) as ASA 2, and 67 (21.1%) as ASA 3. An association between the ASA classification and the main clinicopathological variables of RCC was observed. The univariate analysis for overall survival (OS) revealed significant differences in the survival curves according to the ASA classification (p < 0.001). High-grade neoplasms, the presence of metastasis at diagnosis, clinical stage III/IV, and incidental tumors remained as independent predictors of survival. Moreover, the multivariate analysis revealed a negative impact of the ASA classification on OS (p = 0.001). Conclusions: The present study demonstrated a correlation between the ASA classification and the main prognostic factors of RCC and its impact on survival rates. ASA 3 patients had more aggressive tumors, increased risk of perioperative complications, and worse outcomes compared with ASA1 or ASA 2. Thus, the ASA classification may be considered an additional tool for assessing and planning the treatment of RCC patients.
Highlights
Renal cell carcinoma (RCC) accounts for 3% of malignnant neoplasms in adults, and its incidence has increased over the last 20 years [1,2,3]
Incidental tumors accounted for 47% of cases, 37 patients (11.6%) exhibited metastases at diagnosis, and clear cell carcinoma was the most common histological type found in 156 patients (74%)
The risk of death from other causes was approximately 4 times higher in the American Society of Anesthesiologists (ASA) 3 patients compared with the ASA 2 patients (p = 0.002). These findings demonstrate the importance and effect of comorbidities assessed by the ASA in the prognosis of patients subjected to surgical treatment for renal cell carcinoma (RCC)
Summary
Renal cell carcinoma (RCC) accounts for 3% of malignnant neoplasms in adults, and its incidence has increased over the last 20 years [1,2,3]. The incidental diagnosis is increasing worldwide, the mortality has not decreased [4]. 30% of patients present with metastases at diagnosis, and approximately 40% of those individuals treated for localized disease may experience recurrence [5]. The angiogenesis, apoptosis, and cell cycle biomarkers are underutilized in clinical practice and have a prognostic potential that is not yet well established for RCC [9]. The development of more accurate prognostic factors is extremely important for individualized therapeutic planning [10,11,12]
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