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 language | English (US) |
|---|---|
| Pages (from-to) | 473-480 |
| Number of pages | 8 |
| Journal | World Journal of Urology |
| Volume | 29 |
| Issue number | 4 |
| DOIs | |
| State | Published - Jan 1 2011 |
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All Science Journal Classification (ASJC) codes
- Urology
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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 journal › Review 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.
UR - http://www.scopus.com/inward/record.url?scp=84943015147&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84943015147&partnerID=8YFLogxK
U2 - 10.1007/s00345-011-0677-0
DO - 10.1007/s00345-011-0677-0
M3 - Review article
AN - SCOPUS:84943015147
VL - 29
SP - 473
EP - 480
JO - World Journal of Urology
JF - World Journal of Urology
SN - 0724-4983
IS - 4
ER -