title: Advanced patient age is associated with inferior cancer-specific survival after radical nephroureterectomy.
abstract: OBJECTIVE
  To assess the impact of patient age on outcomes after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
  
  
  METHODS
  Data were collected on 1453 patients treated with RNU at 13 centres. Pathological slides were reviewed by dedicated genitourinary pathologists according to standardized criteria. Age at RNU was analysed both as a continuous and categorical variable (<50, n = 85; 50-59.9, n = 229; 60-69.9, n = 416; 70-79.9, n = 523; > or =80 years, n = 200). RESULTS Patients aged <50 years were less likely to have undergone previous ureteroscopy and to have a history of bladder cancer (P < or = 0.026). Advanced age was associated with infiltrative architecture and female gender (P < or = 0.003). Patients aged >70 years were less likely to undergo lymphadenectomy and to receive adjuvant chemotherapy (P < or = 0.026). In multivariable analyses, being older was associated with decreased all-cause (AC) survival (>60 years) and cancer-specific survival (CSS; >80 years) after controlling for the effects of standard pathological features (P < or = 0.006). However, addition of age did not improve the predictive accuracy of a base model that included standard pathological features for prediction of either disease recurrence, AC survival or CSS.
  
  
  CONCLUSIONS
  Being older at the time of RNU was associated with decreased survival. This finding could be due to a change in the biological potential of the tumour cell, a decrease in the host's defence mechanisms, or differences in care patterns. Further work is needed to improve our understanding of UTUC outcomes in this growing segment of the population and to develop strategies to improve cancer control in the elderly.
authors.affiliation: University of Texas Southwestern, Dallas, TX, USA. shariats@mskcc.org
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Guilherme
authors.initials: G
authors.lastname: Godoy
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Michael
authors.initials: M
authors.lastname: Droller
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Alon
authors.initials: A
authors.lastname: Weizer
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Koppie
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Wheat
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D014513:Ureter / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods; D014571:Urologic Neoplasms / Q000401:mortality* / Q000473:pathology