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Guide
Patients with upper urothelial carcinoma (UTUC) are older at the time of onset, about 70 to 90 years old
.
Previous studies have confirmed that the prognosis of older patients is generally poor
.
Therefore, if radical surgery is required, clinicians must consider the overall situation and comorbidities of the older patient
.
Based on this, foreign researchers evaluated the effects of age, American Society of Anesthesiologists physiological state rating (ASA) and Charlson comorbidity index (CCI) on the survival outcomes of UTUC patients.
Although approximately two-thirds of patients with upper urothelial carcinoma (UTUC) present with aggressive disease, most patients do not metastasize at the time of onset, and radical ureterectomy (RNU) remains the standard of care
.
The 5-year tumor-specific survival rate of patients treated with RUN is approximately 75%.
Given the age of onset and poor physical condition of patients with UTUC, it is necessary to consider whether age, risk of anesthesia, and pre-existing comorbidities have an impact
on survival outcomes in UTUT patients after RNU.
This study is one of the largest global, prospective real-world studies on UTUC management, and its results are informative
.
CROES-UTUC is an international, multicenter study
of patients with UTUC.
The primary endpoints of the study were overall survival (OS) and disease-free survival (DFS).
The investigators grouped patients according to their age (70 years or ≤ 70 years), ASA grade (I.
-II or III.
-IV.
)/CCI (0-1 or ≥2) and performed statistical analysis using Kaplan–Meier survival analysis and multivariate COX regression analysis
.
A total of 2352 patients were included, of whom 70.
6% were male
.
The baseline characteristics of the patient are shown in Table 1
.
Table 1 Baseline characteristics of patients
Of the 2352 patients, 1154 were ≤ 70 years old, and 1198 were > 70 years old
.
Patients aged ≤ 70 years had a higher proportion of smoking (p<0.
001), lower ASA scores (p<0.
001), and lower CCI (p<0.
001<b11>).
However, there were no clear differences
in sex, pathological stage, and proportion of patients receiving RNU between the two age groups.
OS results
In a group analysis based on patient age and ASA grade, the investigators found that patients aged ≤ 70 years with ASA grade I-II had the best OS outcomes, followed by patients aged ≤ 70 years with ASA grade III-IV
.
In a grouping analysis based on patient age and CCI grade, the researchers found that patients aged ≤ 70 years with CCI 0-1 had the best OS outcomes, followed by patients aged ≤70 years with CCI≥2
.
Figure 1 OS data of patients under different groups
Based on the results of multivariate COX regression analysis (Table 2), the investigators found no significant correlation between sex, smoking history, ASA grade, CCI, and RNU and overall survival, and the performance trend was consistent
between the two age groups.
Table 2 Results of multivariate COX regression analysis of OS in patients of different age groups
DFS results
In a grouping analysis based on patient age and ASA grade, the researchers found that patients aged ≤ 70 years with ASA grade III.
-IV.
had the best OS outcomes, followed by patients aged ≤70 years and ASA I.
-II
.
grade.
However, there was no significant difference in DFS between patients by age and CCI (p=0.
496).
Figure 2: DFS data for patients under different subgroups
Based on the results of multivariate COX regression analysis (Table 3), the investigators found that CCI≥3 (HR=5.
100, 95% CI 1.
581-16.
454, p=0.
006) and RNU (HR=0.
262, 95% CI 0.
089-0.
767, p=0.
015) were significantly associated with DFS in patients aged ≤ 70 years.
In patients aged > 70 years, RNU (HR=0.
296, 95% CI 0.
133-0.
659, p=0.
003) was associated with
better DFS.
The study found that gender, smoking history, and ASA rating were not associated with DFS results, and trends were consistent
across age groups.
Table 3 Results of multivariate COX regression analysis of DFS in patients of different age groups
The study suggests that high ASA grade and CCI are not contributing factors to RNU, and RNU therapy may be considered even if UTUC patients are older and after geriatric evaluation is feasible
.
References
Teoh JY, Ng CF, Eto M, Chiruvella M, Capitanio U, Esen T, Zeng G, Lechevallier E, Andonian S, de la Rosette J.
Radical nephroureterectomy for UTUC conferred survival benefits irrespective of age and comorbidities.
World J Urol.
2022 Sep 20.
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