BMC geriatrics · 2026
Geriatric 8 score predicts surgical risk and oncologic outcomes in older patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy.
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Lo Chien-Hsiung, Chang Cheng-Han, Hu Che-Yuan, Ou Yin-Chien, Lin Kun-Che, Tsai Yuh-Shyan, Jan Hau-Chern, Wu Kuan-Yu
Аннотация
BACKGROUND: Accurate preoperative risk stratification remains challenging in older patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). This study evaluated whether preoperative Geriatric 8 (G8) score is associated with perioperative and oncologic outcomes.
METHODS: We retrospectively analyzed 338 patients aged ≥ 65 years who underwent RNU between 2013 and 2022. Patients were classified as G8-low (score ≤ 14) or G8-high (score > 14). Multivariable logistic and Cox regression analyses assessed the association between frailty, postoperative complications (Clavien-Dindo classification), and survival outcomes, including overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS).
RESULTS: Overall, 178 patients (52.7%) were G8-low. G8-low patients exhibited significantly longer hospital stays and higher rates of minor (Clavien I-II: 60.1% vs. 35.6%, p < 0.001) and major complications (Clavien III-V: 12.4% vs. 3.7%, p = 0.004). Multivariable analysis identified G8-low as an independent predictor of postoperative complications (OR 2.51; 95% CI 1.50-4.20; p < 0.001), demonstrating superior prognostic value compared to ASA classification. Furthermore, G8-low remained an independent predictor of worse OS (HR 1.76, 95% CI 1.17-2.65; p = 0.006), CSS (HR 2.00, 95% CI 1.31-3.07; p = 0.001), and PFS (HR 1.73, 95% CI 1.20-2.50; p = 0.004).
CONCLUSIONS: Preoperative G8-low status, is independently associated with increased postoperative complications and poorer oncologic outcomes in older UTUC patients undergoing RNU. Incorporating G8 screening into routine preoperative evaluation may facilitate accurate risk stratification, aiding shared decision-making regarding radical versus nephron-sparing approaches.
METHODS: We retrospectively analyzed 338 patients aged ≥ 65 years who underwent RNU between 2013 and 2022. Patients were classified as G8-low (score ≤ 14) or G8-high (score > 14). Multivariable logistic and Cox regression analyses assessed the association between frailty, postoperative complications (Clavien-Dindo classification), and survival outcomes, including overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS).
RESULTS: Overall, 178 patients (52.7%) were G8-low. G8-low patients exhibited significantly longer hospital stays and higher rates of minor (Clavien I-II: 60.1% vs. 35.6%, p < 0.001) and major complications (Clavien III-V: 12.4% vs. 3.7%, p = 0.004). Multivariable analysis identified G8-low as an independent predictor of postoperative complications (OR 2.51; 95% CI 1.50-4.20; p < 0.001), demonstrating superior prognostic value compared to ASA classification. Furthermore, G8-low remained an independent predictor of worse OS (HR 1.76, 95% CI 1.17-2.65; p = 0.006), CSS (HR 2.00, 95% CI 1.31-3.07; p = 0.001), and PFS (HR 1.73, 95% CI 1.20-2.50; p = 0.004).
CONCLUSIONS: Preoperative G8-low status, is independently associated with increased postoperative complications and poorer oncologic outcomes in older UTUC patients undergoing RNU. Incorporating G8 screening into routine preoperative evaluation may facilitate accurate risk stratification, aiding shared decision-making regarding radical versus nephron-sparing approaches.