Advanced Age Impacts Survival After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma.
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Ferro Matteo, Chiujdea Sever, Vartolomei Mihai Dorin, Bove Pierluigi, Porreca Angelo, Busetto Gian Maria, Del Giudice Francesco, Antonelli Alessandro, Foschi Nazario, Racioppi Marco, Autorino Riccardo, Chiancone Francesco, Longo Nicola, Barone Biagio, Crocetto Felice, Musi Gennaro, Luzzago Stefano, Piccinelli Mattia Luca, Mistretta Francesco Alessandro, de Cobelli Ottavio, Tataru Octavian Sabin, Hurle Rodolfo, Liguori Giovanni, Borghesi Marco, Veccia Alessandro, Greco Francesco, Schips Luigi, Marchioni Michele, Lucarelli Giuseppe, Dutto Daniele, Colucci Fulvia, Russo Giorgio Ivan, Giudice Arturo Lo, Montanari Emanuele, Boeri Luca, Simone Giuseppe, Rosazza Matteo, Livoti Simone, Gontero Paolo, Soria Francesco
Аннотация
PATIENTS AND METHODS: From 1387 patients with clinically nonmetastatic upper tract urothelial carcinoma treated with radical nephroureterectomy at 21 academic hospital centers between 2005 and 2021, 776 patients were eligible and included in the study. Univariable and multivariable Cox regression models were built to evaluate the independent prognosticators for intravesical and extravesical recurrence, overall survival, and cancer-specific survival according to age groups. A P value of <.05 was considered statistically significant.
RESULTS: We did not find an association between groups aged <70 and >70 years old and preoperatively clinical or histopathological characteristics. Kaplan-Meier analysis was found no statistical significance between the 2 age groups in terms of intravesical or extravesical recurrence (P = .09 and P = .57). Overall survival (P = .0001) and cancer-specific survival (P = .0001) have been found to be statistically significantly associated with age as independent predictors (confounding factors: gender, tumor size, tumor side, clinical T stage, localization, preoperative hydronephrosis, tumor localization, type of surgery, multifocality of the tumor, pathological grade, lymphovascular invasion, concomitant CIS, lymph node status, necrosis, or history of previous bladder cancer).
CONCLUSION: This research confirms that patients aged 70 and above who undergo radical nephroureterectomy may have worse outcomes compared to younger patients, older patients needing an improved care and management of UTUC to improve their outcomes in the setting of an increase in this aged population group.