title: Impact of the ASA Physical Status Score on Adjuvant Chemotherapy Eligibility and Survival of Upper Tract Urothelial Carcinoma Patients: a Multicenter Study.
abstract: The aim of the present multi-institutional study was to assess the influence of the American Society of Anesthesiologists Physical Status (ASA-PS) classification on adjuvant chemotherapy eligibility and survival in a multi-institutional cohort of patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). We retrospectively reviewed data from 416 patients who underwent RNU for UTUC at four Korean institutions between 2001 and 2013. The ASA-PS classification was obtained from the anesthesia chart. Locally advanced UTUC was defined as ≥ pT3 and/or pN1 disease. The influence of ASA-PS score on survival was evaluated by Kaplan-Meier analyses and a multivariate Cox regression model. Patients with a higher ASA-PS class were less likely to be eligible for adjuvant chemotherapy in locally advanced UTUC (P = 0.016). Kaplan-Meier estimates showed that the high-risk ASA-PS group has a poorer overallsurvival (OS) and cancer-specific survival (CSS) compared to low risk ASA-PS groups in both the total and locally advanced UTUC cohorts. Based on multivariate Cox regression analysis, the high-risk ASA-PS category was an independent predictor for overall mortality (OM) (hazard ratio [HR], 1.919; 95% confidence interval [CI], 1.017-3.619; P = 0.044) and cancer-specific mortality (CSM) (HR, 2.120; 95% CI, 1.023-4.394; P = 0.043). In conclusion, high-risk ASA-PS score was independently associated with a lower survival rate in patients with UTUC after RNU. However, the influence of ASA-PS classification on survival was limited to locally advanced UTUC. The lower eligibility of patients in the high-risk ASA category for adjuvant chemotherapy may contribute to the lower survival rate in this group.
authors.affiliation: Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea.
authors.forename: Ho Won
authors.identifier: http://orcid.org/0000-0002-8164-4427
authors.initials: HW
authors.lastname: Kang
authors.affiliation: Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea.
authors.forename: Sung Pil
authors.identifier: http://orcid.org/0000-0001-6179-7031
authors.initials: SP
authors.lastname: Seo
authors.affiliation: Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea.
authors.forename: Won Tae
authors.identifier: http://orcid.org/0000-0002-7482-4550
authors.initials: WT
authors.lastname: Kim
authors.affiliation: Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea.
authors.forename: Yong June
authors.identifier: http://orcid.org/0000-0001-7638-7174
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea.
authors.forename: Seok Joong
authors.identifier: http://orcid.org/0000-0001-7737-4746
authors.initials: SJ
authors.lastname: Yun
authors.affiliation: Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea.
authors.forename: Sang Cheol
authors.identifier: http://orcid.org/0000-0002-4163-2210
authors.initials: SC
authors.lastname: Lee
authors.affiliation: Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Deuk
authors.identifier: http://orcid.org/0000-0002-8545-5797
authors.initials: YD
authors.lastname: Choi
authors.affiliation: Departments of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Yun Sok
authors.identifier: http://orcid.org/0000-0003-3732-9814
authors.initials: YS
authors.lastname: Ha
authors.affiliation: Departments of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Tae Hwan
authors.identifier: http://orcid.org/0000-0001-7711-9534
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Departments of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Tae Gyun
authors.identifier: http://orcid.org/0000-0002-4390-0952
authors.initials: TG
authors.lastname: Kwon
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Seok Soo
authors.identifier: http://orcid.org/0000-0001-9356-9500
authors.initials: SS
authors.lastname: Byun
authors.affiliation: Department of Urology, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Seong Uk
authors.identifier: http://orcid.org/0000-0002-0206-0555
authors.initials: SU
authors.lastname: Jeh
authors.affiliation: Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea. wjkim@chungbuk.ac.kr.
authors.forename: Wun Jae
authors.identifier: http://orcid.org/0000-0002-8060-8926
authors.initials: WJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014571:Urologic Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents
keywords: Nephroureterectomy; Physical Status Classification; Survival; Upper Urinary Tract; Urothelial Carcinoma