title: 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 2b. What'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).
  
  
  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.
authors.affiliation: Berod Academic Department of Urology, CHRU Grenoble, University of Grenoble, Grenoble, France.
authors.forename: Alexis Arvin
authors.initials: AA
authors.lastname: Berod
authors.forename: Pierre
authors.initials: P
authors.lastname: Colin
authors.forename: David R
authors.initials: DR
authors.lastname: Yates
authors.forename: Adil
authors.initials: A
authors.lastname: Ouzzane
authors.forename: Marie
authors.initials: M
authors.lastname: Audouin
authors.forename: Emilie
authors.initials: E
authors.lastname: Adam
authors.forename: Frédéric
authors.initials: F
authors.lastname: Arroua
authors.forename: Charles
authors.initials: C
authors.lastname: Marchand
authors.forename: Pierre
authors.initials: P
authors.lastname: Bigot
authors.forename: Michel
authors.initials: M
authors.lastname: Soulié
authors.forename: Mathieu
authors.initials: M
authors.lastname: Roumiguié
authors.forename: Thomas
authors.initials: T
authors.lastname: Polguer
authors.forename: Solène
authors.initials: S
authors.lastname: Gardic
authors.forename: Pascal
authors.initials: P
authors.lastname: Grès
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Ravier
authors.forename: Yann
authors.initials: Y
authors.lastname: Neuzillet
authors.forename: Francky
authors.initials: F
authors.lastname: Delage
authors.forename: Thomas
authors.initials: T
authors.lastname: Bodin
authors.forename: Géraldine
authors.initials: G
authors.lastname: Pignot
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000368:Aged; D000776:Anesthesiology; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012955:Societies, Medical; D015996:Survival Rate / Q000639:trends; D014481:United States; D014516:Ureteral Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology