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    Home > Active Ingredient News > Urinary System > Research Frontiers Does Age Affect the Prognosis of RNU in UTUC Patients?

    Research Frontiers Does Age Affect the Prognosis of RNU in UTUC Patients?

    • Last Update: 2023-01-06
    • Source: Internet
    • Author: User
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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.











    background


    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
    .


    Research methods


    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

    .


    Study results


    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


    conclusion


    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.


    Editor: LR Reviser: LR Executive: LR


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