title: Chronological age is not an independent predictor of clinical outcomes after radical nephroureterectomy.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Urology, Weill Cornell Medical Center, New York-Presbyterian Hospital, New York, NY 10065, USA.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Chromecki
authors.forename: Behfar
authors.initials: B
authors.lastname: Ehdaie
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Karl
authors.initials: K
authors.lastname: Pummer
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Christian
authors.initials: C
authors.lastname: Seitz
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.forename: Richard K
authors.initials: RK
authors.lastname: Lee
authors.forename: Eugene K
authors.initials: EK
authors.lastname: Cha
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Casey
authors.initials: C
authors.lastname: Ng
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
authors.forename: Felix K
authors.initials: FK
authors.lastname: Chun
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walton
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Juan I
authors.initials: JI
authors.lastname: Martínez-Salamanca
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009399:Nephrons / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D019459:Urothelium / Q000473:pathology