title: Prognostic role of ECOG performance status in patients with urothelial carcinoma of the upper urinary tract: an international study.
abstract: OBJECTIVE
  To evaluate the prognostic role of ECOG Performance status (ECOG-PS) in a large multi-institutional international cohort of patients treated with radical nephroureterectomy for upper tract urothelial carcinoma.
  
  
  METHODS
  Data of 427 patients treated with radical nephroureterectomy at five international institutions in Asia, Europe and Northern America were collected retrospectively from 1987 to 2008. Logistic and Cox regression models were used for univariable and multivariable analyses.
  
  
  RESULTS
  ECOG-PS was 0 in 272 of 427 (64%) patients. The median follow-up of the whole cohort was 32 months. The five-year recurrence-free (RFS), cancer-specific (CSS) and overall (OS) survival estimates were 71.7%, 74.9% and 68.5%, respectively, in patients with ECOG-PS 0 compared with 60.1%, 67.8%, and 51.4% respectively, in patients with ECOG-PS ≥1 (P value 0.08 for RFS, 0.43 for CSS, and <0.001 for OS, respectively). On multivariable Cox regression analyses, ECOG-PS was not an independent predictor of either RFS (hazard ratio 1.4; P = 0.107) or CSS (hazard ratio 1.2; P = 0.426) but was an independent predictor of OS (hazard ratio 1.5; P = 0.03).
  
  
  CONCLUSIONS
  In this large multicentre international study, ECOG-PS was not significantly associated with RFS and CSS. Conversely we find a strong association with survival 1-month after surgery and OS. Further research is needed to ascertain the additive prognostic role of ECOG-PS in well-designed prospective multicentre studies.
authors: Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Spain.
authors: Juan Ignacio
authors: JI
authors: Martinez-Salamanca
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Joaquin Carballido
authors: JC
authors: Rodriguez
authors: Thomas F
authors: TF
authors: Chromecki
authors: Vincenzo
authors: V
authors: Ficarra
authors: Hans-Martin
authors: HM
authors: Fritsche
authors: Wassim
authors: W
authors: Kassouf
authors: Kazumasa
authors: K
authors: Matsumoto
authors: Lucia Osorio
authors: LO
authors: Cabello
authors: Christian
authors: C
authors: Seitz
authors: Stefan
authors: S
authors: Tritschler
authors: Thomas J
authors: TJ
authors: Walton
authors: Filiberto
authors: F
authors: Zattoni
authors: Giacomo
authors: G
authors: Novara
mesh_terms: D000368:Aged; D001208:Asia / Q000453:epidemiology; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009656:North America / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D013520:Urologic Surgical Procedures