TALL score for prediction of oncological outcomes after radical nephroureterectomy for high-grade upper tract urothelial carcinoma

Ramy F. Youssef, Laura Maria Krabbe, Shahrokh F. Shariat, Yair Lotan, Arthur I Sagalowsky, Jay Raman, Christopher G. Wood, Alon Weizer, Marco Roscigno, Francesco Montorsi, Christian Bolenz, Mesut Remzi, Karim Bensalah, Wassim Kassouf, Vitaly Margulis

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Purpose: 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.

Original languageEnglish (US)
Pages (from-to)1965-1972
Number of pages8
JournalWorld journal of urology
Volume33
Issue number12
DOIs
StatePublished - Dec 1 2015

Keywords

  • Grade
  • Prediction
  • Prognosis
  • Score
  • Upper urinary tract
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

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