title: TALL score for prediction of oncological outcomes after radical nephroureterectomy for high-grade upper tract urothelial carcinoma.
abstract: OBJECTIVE
  We created a prognostic tool for the prediction of oncologic outcomes after radical nephroureterectomy (RNU) for high-grade non-metastatic upper tract urothelial carcinoma (UTUC).
  
  
  METHODS
  UTUC collaboration was utilized to include 586 patients who underwent RNU for non-metastatic high-grade UTUC. Survival outcomes were compared according to a score defined based on the sum of the independent prognostic variables.
  
  
  RESULTS
  The study included 382 males with a median age 70 years (range 28-97). Independent prognostic factors included: T (t stage), A (architecture), LVI (lympho-vascular invasion) and L (lymphadenectomy). TALL score (1-7) was the sum of T (≤T1 = 1, T2 = 2, T3 = 3 and T4 = 4), A (papillary = 0 and sessile = 1), LVI (absent = 0 and present = 1) and L (lymphadenectomy = 0 and no lymphadenectomy = 1). Five-year disease-free survival (DFS) and cancer-specific survival (CSS) were stratified into four risk categories according to the TALL score: low (TALL 0-2; 86 % DFS and 90 % CSS), intermediate (TALL = 3; 71 % DFS and 75 % CSS), high (TALL = 4; 57 % DFS and 58 % CSS) and very high risk (TALL ≥ 5; 34 % DFS and 38 % CSS) using Kaplan-Meier survival analyses. TALL score was externally validated in a single-center cohort of 85 UTUC patients.
  
  
  CONCLUSIONS
  We developed a multivariable prognostic tool for the prediction of oncological outcomes after RNU for high-grade UTUC. The score can be used for patient counseling, selection for adjuvant systemic therapies and design of clinical trials.
authors.affiliation: University of California, Irvine, Orange, CA, USA. ramy.yaacoub@utsouthwestern.edu.
authors.forename: Ramy F
authors.initials: RF
authors.lastname: Youssef
authors.affiliation: University of Muenster Medical Center, Muenster, Germany.
authors.forename: Laura-Maria
authors.initials: LM
authors.lastname: Krabbe
authors.affiliation: Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.affiliation: UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.affiliation: Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Raman
authors.affiliation: UT M.D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Alon
authors.initials: A
authors.lastname: Weizer
authors.affiliation: AO Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.affiliation: Vita Salute University, San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Mannheim Medical Center, University of Heidelberg, Mannheim, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.affiliation: Landesklinikum Korneuburg, Korneuburg, Austria.
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.affiliation: Bicêtre University Hospital, Le Kremlin Bicêtre, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.affiliation: McGill University Health Center, Montreal, QC, Canada.
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.affiliation: UT Southwestern Medical Center, Dallas, TX, USA. Vitaly.Margulis@utsouthwestern.edu.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D019459:Urothelium
keywords: Grade; Prediction; Prognosis; Score; Upper urinary tract; Urothelial carcinoma