Impact of the ASA physical status score on adjuvant chemotherapy eligibility and survival of upper tract urothelial carcinoma patients: A multicenter study

Ho Won Kang, Sung Pil Seo, Won Tae Kim, Yong June Kim, Seok Joong Yun, Sang Cheol Lee, Young Deuk Choi, Yun Sok Ha, Tae Hwan Kim, Tae Gyun Kwon, Seok Soo Byun, Seong Uk Jeh, Wun Jae Kim

Research output: Contribution to journalArticle

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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 highrisk 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.

Original languageEnglish
Pages (from-to)335-342
Number of pages8
JournalJournal of Korean Medical Science
Volume32
Issue number2
DOIs
StatePublished - 1 Jan 2017

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Adjuvant Chemotherapy
Multicenter Studies
Carcinoma
Survival
Kaplan-Meier Estimate
Survival Rate
Confidence Intervals
Mortality
Anesthesiologists
Proportional Hazards Models
Neoplasms
Anesthesia
Regression Analysis

Keywords

  • Nephroureterectomy
  • Physical status classification
  • Survival
  • Upper urinary tract
  • Urothelial carcinoma

Cite this

Kang, Ho Won ; Seo, Sung Pil ; Kim, Won Tae ; Kim, Yong June ; Yun, Seok Joong ; Lee, Sang Cheol ; Choi, Young Deuk ; Ha, Yun Sok ; Kim, Tae Hwan ; Kwon, Tae Gyun ; Byun, Seok Soo ; Jeh, Seong Uk ; Kim, Wun Jae. / Impact of the ASA physical status score on adjuvant chemotherapy eligibility and survival of upper tract urothelial carcinoma patients : A multicenter study. In: Journal of Korean Medical Science. 2017 ; Vol. 32, No. 2. pp. 335-342.
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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 highrisk 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.",
keywords = "Nephroureterectomy, Physical status classification, Survival, Upper urinary tract, Urothelial carcinoma",
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Impact of the ASA physical status score on adjuvant chemotherapy eligibility and survival of upper tract urothelial carcinoma patients : A multicenter study. / Kang, Ho Won; Seo, Sung Pil; Kim, Won Tae; Kim, Yong June; Yun, Seok Joong; Lee, Sang Cheol; Choi, Young Deuk; Ha, Yun Sok; Kim, Tae Hwan; Kwon, Tae Gyun; Byun, Seok Soo; Jeh, Seong Uk; Kim, Wun Jae.

In: Journal of Korean Medical Science, Vol. 32, No. 2, 01.01.2017, p. 335-342.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of the ASA physical status score on adjuvant chemotherapy eligibility and survival of upper tract urothelial carcinoma patients

T2 - A multicenter study

AU - Kang, Ho Won

AU - Seo, Sung Pil

AU - Kim, Won Tae

AU - Kim, Yong June

AU - Yun, Seok Joong

AU - Lee, Sang Cheol

AU - Choi, Young Deuk

AU - Ha, Yun Sok

AU - Kim, Tae Hwan

AU - Kwon, Tae Gyun

AU - Byun, Seok Soo

AU - Jeh, Seong Uk

AU - Kim, Wun Jae

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Y1 - 2017/1/1

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AB - 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 highrisk 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.

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KW - Physical status classification

KW - Survival

KW - Upper urinary tract

KW - Urothelial carcinoma

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