TY - JOUR
T1 - Prognostic Value of Comorbidity for Patients with Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy
AU - Ke, Hung Lung
AU - Li, Ching Chia
AU - Lee, Hsiang Ying
AU - Tu, Hung Pin
AU - Wei, Yu Ching
AU - Yeh, Hsin Chih
AU - Wu, Wen Jeng
AU - Li, Wei Ming
N1 - Funding Information:
Funding: This research was funded by Kaohsiung Medical University Hospital, Taiwan (KMUH109-9R60, KMUH110-0R59, KMUH-DK(C)-110006), Kaohsiung Medical University Research Center, Taiwan (KMU-TC109B05), and Ministry of Science and Technology, Taiwan (MOST109-2314-B-037-110-MY3, MOST110-2321-B-037-002).
Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Patients with upper tract urothelial carcinoma (UTUC) have a high prevalence of comorbidi-ties. However, the prognostic impact of comorbidities in these patients is not well studied. We aimed to outline the comorbidity burden in UTUC patients and investigate its relationship with overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). We retrospectively reviewed the clinicopathological data of 409 non-metastatic UTUC patients who received radical nephroureterectomy between 2000 and 2015. The comorbidity burden was evaluated using the Adult Comorbidity Evaluation-27 (ACE-27). Kaplan-Meier survival analysis showed that high ACE-27 grade was significantly associated with worse PFS, CSS, and OS. In multivariate Cox regression and competing risk analyses, we found that ACE-27 grade, tumor stage, and tumor grade were independent prognosticators of OS, CSS, and PFS. We combined these three significant factors to construct a prognostic model for predicting clinical outcomes. A receiver operating characteristic curve revealed that our prognostic model had high predictive performance. The Harrel’s concordance indices of this model for predicting OS, CSS, and PFS were 0.81, 0.85, and 0.85, respectively. The results suggest that the UTUC patient comorbidity burden (ACE-27) provides information on the risk for meaningful clinical outcomes of OS, CSS, and PFS.
AB - Patients with upper tract urothelial carcinoma (UTUC) have a high prevalence of comorbidi-ties. However, the prognostic impact of comorbidities in these patients is not well studied. We aimed to outline the comorbidity burden in UTUC patients and investigate its relationship with overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). We retrospectively reviewed the clinicopathological data of 409 non-metastatic UTUC patients who received radical nephroureterectomy between 2000 and 2015. The comorbidity burden was evaluated using the Adult Comorbidity Evaluation-27 (ACE-27). Kaplan-Meier survival analysis showed that high ACE-27 grade was significantly associated with worse PFS, CSS, and OS. In multivariate Cox regression and competing risk analyses, we found that ACE-27 grade, tumor stage, and tumor grade were independent prognosticators of OS, CSS, and PFS. We combined these three significant factors to construct a prognostic model for predicting clinical outcomes. A receiver operating characteristic curve revealed that our prognostic model had high predictive performance. The Harrel’s concordance indices of this model for predicting OS, CSS, and PFS were 0.81, 0.85, and 0.85, respectively. The results suggest that the UTUC patient comorbidity burden (ACE-27) provides information on the risk for meaningful clinical outcomes of OS, CSS, and PFS.
KW - Adult Comorbidity Evaluation-27
KW - Comorbidity
KW - Prognosis
KW - Upper tract urothelial carcinoma
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U2 - 10.3390/cancers14061466
DO - 10.3390/cancers14061466
M3 - Article
C2 - 35326617
AN - SCOPUS:85126284422
SN - 2072-6694
VL - 14
JO - Cancers
JF - Cancers
IS - 6
M1 - 1466
ER -