The role of American Society of Anesthesiologists scores in predicting urothelial carcinoma of the upper urinary tract outcome after radical nephroureterectomy: results from a national multi‐institutional collaborative study

Abstract

Study Type – Prognosis (cohort)Level of Evidence 2bWhat's known on the subject? and What does the study add?Upper urinary tract urothelial carcinoma (UUT‐UC) is a rare disease, usually treated by nephroureterectomy, occurring in a population with a median age of 70 years and with frequent tobacco use and other comorbidities. We know that the American Society of Anesthesiologists (ASA) score has prognostic value in urological oncology but this has not been assessed in UUT‐UC.Using a multi‐institutional French database, we have shown that the 5‐year cancer‐specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P= 0.01). ASA status had a significant impact on cancer‐specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients (P= 0.04).OBJECTIVE To evaluate the impact of American Society of Anesthesiologists (ASA) scores on the survival of patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UUT‐UC). PATIENTS AND METHODS A retrospective multi‐institutional cohort study of the French collaborative national database of UUT‐UC treated by RNU in 20 centres from 1995 to 2010. The influence of age, gender and ASA score on survival was assessed using a univariable and multivariable Cox regression analysis with pathological features used as covariables. RESULTS Overall, 554 patients were included. The median follow‐up was 26 months (10–48 months), and the median age was 69.5 years (61–76 years). In total, 114 (20.6%) patients were classified as ASA 1, 326 (58.8%) as ASA 2 and 114 (20.6%) as ASA 3. The 5‐year recurrence‐free survival (P= 0.21) and metastasis‐free survival (P= 0.22) were not significantly different between ASA 1 (52.8% and 76%), ASA 2 (51.9% and 75.3%) and ASA 3 patients (44.1% and 68.2%, respectively). The 5‐year cancer‐specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P= 0.01). ASA status had a significant impact on cancer‐specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients (P= 0.04). CONCLUSIONS ASA classification correlates significantly with cancer‐specific survival after RNU for UUT‐UC. It is a further pre‐operative clinical variable that can be incorporated into future risk prediction tools for UUT‐UC to improve their accuracy.

Impact of the ASA Physical Status Score on Adjuvant Chemotherapy Eligibility and Survival of Upper Tract Urothelial Carcinoma Patients: a Multicenter Study

“…For example, a large national multi-center collaborative study found that the ASA classification significantly correlated with CSS after RNU for UTUC. In this study, the 5-year CSS differed significantly between ASA 1, 2, and 3 patients (83.8%, 76.9%, and 70.6%, respectively), and there was a threefold higher risk of OM and CSM at 5 years for patients rated as ASA 3 compared with ASA 1 (25). In a recent study by Aziz et al (26), 4 comorbidity indices (ASA-PS, CCI, ACCI, and ECOG-PS) were compared with regard to recurrence-free survival (RFS), CSS, OS, and CIM.…”

Risk of chronic kidney disease after cancer nephrectomy

“…14 A study that included 290 patients from the Memorial SloanKettering Cancer Center (MSKCC), New York, USA, with a median follow-up of 25 months reported similar findings. At baseline the radical and partial nephrectomy groups had similar mean preoperative serum creatinine levels (88.4 μmol/l and 86.63 μmol/l, respectively) and were comparable in terms of risk factors for renal insufficiency, including diabetes mellitus, hyper tension, age, American Society of Anaesthesiologists score for physical status, 26 and smoking status. At the end of the follow-up period, the mean postoperative serum creatinine level was significantly higher in the radical nephrectomy group than in the partial nephrectomy group (132.6 μmol/l versus 88.4 μmol/l, P <0.001).…”

Facteurs pronostiques des tumeurs de la voie excrétrice supérieure et impact sur la survie : une revue systématique pour le rapport annuel de l’Association française d’urologie

“…Inversement, l'âge élevé a été rapporté comme un facteur pronostique corrélé à une survie spécifique (SSP) défavorable [8][9][10].…”

“…Le retentissement de la maladie tumorale est évaluée par le score d'état général (score ECOG-Perfomance Status) ou par les comorbidités (score ASA) [10,11]. Ces deux systèmes de classification préopératoire sont apparus comme des facteurs pronostiques indépendants en termes de survie globale (SG) [10,11].…”

“…Ces deux systèmes de classification préopératoire sont apparus comme des facteurs pronostiques indépendants en termes de survie globale (SG) [10,11]. Par ailleurs, le score ECOG-PS (≥ 1) était également un facteur indépendant de SSP [10,12,13].…”