Chronological age is not an independent predictor of clinical outcomes after radical nephroureterectomy

Thomas F. Chromecki, Behfar Ehdaie, Giacomo Novara, Karl Pummer, Richard Zigeuner, Christian Seitz, Armin Pycha, Richard K. Lee, Eugene K. Cha, Pierre I. Karakiewicz, Casey Ng, Jay Raman, Felix K. Chun, Hans Martin Fritsche, Kazumasa Matsumoto, Wassim Kassouf, Thomas J. Walton, Patrick J. Bastian, Juan I. Martínez-Salamanca, Douglas S. ScherrShahrokh F. Shariat

Research output: Contribution to journalReview article

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Abstract

Purpose: Higher chronological age has been suggested to confer worse prognosis in patients with upper tract urothelial carcinoma (UTUC). The aim of the current study was to test this hypothesis in a large multicenter external validation cohort of patients treated with radical nephroureterectomy (RNU) while controlling for patient performance status. Materials and methods: We retrospectively reviewed the data from 1,169 patients treated with RNU for UTUC. Age at RNU was analyzed both as a continuous and categorical variable (<50 years, n = 66; 50-59. 9 years, n = 185; 60-69.9 years, n = 367; 70-79.9 years, n = 419; ≥80 years, n = 132). Median follow-up was 37 months. Results: Actuarial recurrence-free, cancer-specific, and all-cause survival estimates at 5 years after RNU were 69, 73, and 61%, respectively. Advanced age was associated with female gender, higher ECOG status, higher ASA score, and a lower probability of receiving adjuvant chemotherapy (all P values ≤ 0.02). In multivariable analyses, advanced age was associated with decreased recurrence-free (P = 0.021), cancer-specific (P = 0.002), and all-cause survival (P < 0.001) after controlling for the effects of gender, tumor location, number of lymph nodes removed, tumor grade, stage, architecture, necrosis, and lymphovascular invasion. After addition of ECOG status, age remained an independent predictor of only all-cause mortality (P > 0.001). Conclusions: We confirmed that advanced patient age at the time of RNU is associated with worse clinical outcomes after surgery. However, ECOG performance status abrogated the association. Furthermore, a large proportion of elderly patients were cured with RNU. This suggests that chronological age alone is an inadequate indicator criterion to predict response of older UTUC patients to RNU.

Original languageEnglish (US)
Pages (from-to)473-480
Number of pages8
JournalWorld Journal of Urology
Volume29
Issue number4
DOIs
StatePublished - Jan 1 2011

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Carcinoma

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Chromecki, T. F., Ehdaie, B., Novara, G., Pummer, K., Zigeuner, R., Seitz, C., ... Shariat, S. F. (2011). Chronological age is not an independent predictor of clinical outcomes after radical nephroureterectomy. World Journal of Urology, 29(4), 473-480. https://doi.org/10.1007/s00345-011-0677-0
Chromecki, Thomas F. ; Ehdaie, Behfar ; Novara, Giacomo ; Pummer, Karl ; Zigeuner, Richard ; Seitz, Christian ; Pycha, Armin ; Lee, Richard K. ; Cha, Eugene K. ; Karakiewicz, Pierre I. ; Ng, Casey ; Raman, Jay ; Chun, Felix K. ; Fritsche, Hans Martin ; Matsumoto, Kazumasa ; Kassouf, Wassim ; Walton, Thomas J. ; Bastian, Patrick J. ; Martínez-Salamanca, Juan I. ; Scherr, Douglas S. ; Shariat, Shahrokh F. / Chronological age is not an independent predictor of clinical outcomes after radical nephroureterectomy. In: World Journal of Urology. 2011 ; Vol. 29, No. 4. pp. 473-480.
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title = "Chronological age is not an independent predictor of clinical outcomes after radical nephroureterectomy",
abstract = "Purpose: Higher chronological age has been suggested to confer worse prognosis in patients with upper tract urothelial carcinoma (UTUC). The aim of the current study was to test this hypothesis in a large multicenter external validation cohort of patients treated with radical nephroureterectomy (RNU) while controlling for patient performance status. Materials and methods: We retrospectively reviewed the data from 1,169 patients treated with RNU for UTUC. Age at RNU was analyzed both as a continuous and categorical variable (<50 years, n = 66; 50-59. 9 years, n = 185; 60-69.9 years, n = 367; 70-79.9 years, n = 419; ≥80 years, n = 132). Median follow-up was 37 months. Results: Actuarial recurrence-free, cancer-specific, and all-cause survival estimates at 5 years after RNU were 69, 73, and 61{\%}, respectively. Advanced age was associated with female gender, higher ECOG status, higher ASA score, and a lower probability of receiving adjuvant chemotherapy (all P values ≤ 0.02). In multivariable analyses, advanced age was associated with decreased recurrence-free (P = 0.021), cancer-specific (P = 0.002), and all-cause survival (P < 0.001) after controlling for the effects of gender, tumor location, number of lymph nodes removed, tumor grade, stage, architecture, necrosis, and lymphovascular invasion. After addition of ECOG status, age remained an independent predictor of only all-cause mortality (P > 0.001). Conclusions: We confirmed that advanced patient age at the time of RNU is associated with worse clinical outcomes after surgery. However, ECOG performance status abrogated the association. Furthermore, a large proportion of elderly patients were cured with RNU. This suggests that chronological age alone is an inadequate indicator criterion to predict response of older UTUC patients to RNU.",
author = "Chromecki, {Thomas F.} and Behfar Ehdaie and Giacomo Novara and Karl Pummer and Richard Zigeuner and Christian Seitz and Armin Pycha and Lee, {Richard K.} and Cha, {Eugene K.} and Karakiewicz, {Pierre I.} and Casey Ng and Jay Raman and Chun, {Felix K.} and Fritsche, {Hans Martin} and Kazumasa Matsumoto and Wassim Kassouf and Walton, {Thomas J.} and Bastian, {Patrick J.} and Mart{\'i}nez-Salamanca, {Juan I.} and Scherr, {Douglas S.} and Shariat, {Shahrokh F.}",
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Chromecki, TF, Ehdaie, B, Novara, G, Pummer, K, Zigeuner, R, Seitz, C, Pycha, A, Lee, RK, Cha, EK, Karakiewicz, PI, Ng, C, Raman, J, Chun, FK, Fritsche, HM, Matsumoto, K, Kassouf, W, Walton, TJ, Bastian, PJ, Martínez-Salamanca, JI, Scherr, DS & Shariat, SF 2011, 'Chronological age is not an independent predictor of clinical outcomes after radical nephroureterectomy', World Journal of Urology, vol. 29, no. 4, pp. 473-480. https://doi.org/10.1007/s00345-011-0677-0

Chronological age is not an independent predictor of clinical outcomes after radical nephroureterectomy. / Chromecki, Thomas F.; Ehdaie, Behfar; Novara, Giacomo; Pummer, Karl; Zigeuner, Richard; Seitz, Christian; Pycha, Armin; Lee, Richard K.; Cha, Eugene K.; Karakiewicz, Pierre I.; Ng, Casey; Raman, Jay; Chun, Felix K.; Fritsche, Hans Martin; Matsumoto, Kazumasa; Kassouf, Wassim; Walton, Thomas J.; Bastian, Patrick J.; Martínez-Salamanca, Juan I.; Scherr, Douglas S.; Shariat, Shahrokh F.

In: World Journal of Urology, Vol. 29, No. 4, 01.01.2011, p. 473-480.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Chronological age is not an independent predictor of clinical outcomes after radical nephroureterectomy

AU - Chromecki, Thomas F.

AU - Ehdaie, Behfar

AU - Novara, Giacomo

AU - Pummer, Karl

AU - Zigeuner, Richard

AU - Seitz, Christian

AU - Pycha, Armin

AU - Lee, Richard K.

AU - Cha, Eugene K.

AU - Karakiewicz, Pierre I.

AU - Ng, Casey

AU - Raman, Jay

AU - Chun, Felix K.

AU - Fritsche, Hans Martin

AU - Matsumoto, Kazumasa

AU - Kassouf, Wassim

AU - Walton, Thomas J.

AU - Bastian, Patrick J.

AU - Martínez-Salamanca, Juan I.

AU - Scherr, Douglas S.

AU - Shariat, Shahrokh F.

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Purpose: Higher chronological age has been suggested to confer worse prognosis in patients with upper tract urothelial carcinoma (UTUC). The aim of the current study was to test this hypothesis in a large multicenter external validation cohort of patients treated with radical nephroureterectomy (RNU) while controlling for patient performance status. Materials and methods: We retrospectively reviewed the data from 1,169 patients treated with RNU for UTUC. Age at RNU was analyzed both as a continuous and categorical variable (<50 years, n = 66; 50-59. 9 years, n = 185; 60-69.9 years, n = 367; 70-79.9 years, n = 419; ≥80 years, n = 132). Median follow-up was 37 months. Results: Actuarial recurrence-free, cancer-specific, and all-cause survival estimates at 5 years after RNU were 69, 73, and 61%, respectively. Advanced age was associated with female gender, higher ECOG status, higher ASA score, and a lower probability of receiving adjuvant chemotherapy (all P values ≤ 0.02). In multivariable analyses, advanced age was associated with decreased recurrence-free (P = 0.021), cancer-specific (P = 0.002), and all-cause survival (P < 0.001) after controlling for the effects of gender, tumor location, number of lymph nodes removed, tumor grade, stage, architecture, necrosis, and lymphovascular invasion. After addition of ECOG status, age remained an independent predictor of only all-cause mortality (P > 0.001). Conclusions: We confirmed that advanced patient age at the time of RNU is associated with worse clinical outcomes after surgery. However, ECOG performance status abrogated the association. Furthermore, a large proportion of elderly patients were cured with RNU. This suggests that chronological age alone is an inadequate indicator criterion to predict response of older UTUC patients to RNU.

AB - Purpose: Higher chronological age has been suggested to confer worse prognosis in patients with upper tract urothelial carcinoma (UTUC). The aim of the current study was to test this hypothesis in a large multicenter external validation cohort of patients treated with radical nephroureterectomy (RNU) while controlling for patient performance status. Materials and methods: We retrospectively reviewed the data from 1,169 patients treated with RNU for UTUC. Age at RNU was analyzed both as a continuous and categorical variable (<50 years, n = 66; 50-59. 9 years, n = 185; 60-69.9 years, n = 367; 70-79.9 years, n = 419; ≥80 years, n = 132). Median follow-up was 37 months. Results: Actuarial recurrence-free, cancer-specific, and all-cause survival estimates at 5 years after RNU were 69, 73, and 61%, respectively. Advanced age was associated with female gender, higher ECOG status, higher ASA score, and a lower probability of receiving adjuvant chemotherapy (all P values ≤ 0.02). In multivariable analyses, advanced age was associated with decreased recurrence-free (P = 0.021), cancer-specific (P = 0.002), and all-cause survival (P < 0.001) after controlling for the effects of gender, tumor location, number of lymph nodes removed, tumor grade, stage, architecture, necrosis, and lymphovascular invasion. After addition of ECOG status, age remained an independent predictor of only all-cause mortality (P > 0.001). Conclusions: We confirmed that advanced patient age at the time of RNU is associated with worse clinical outcomes after surgery. However, ECOG performance status abrogated the association. Furthermore, a large proportion of elderly patients were cured with RNU. This suggests that chronological age alone is an inadequate indicator criterion to predict response of older UTUC patients to RNU.

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U2 - 10.1007/s00345-011-0677-0

DO - 10.1007/s00345-011-0677-0

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JO - World Journal of Urology

JF - World Journal of Urology

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