Yuan Yichu, Wang Yiqiu, Zhang Nan, Mao Xiawa, Huang Yiran, Huang Jiwei, Ji Na
Department of Urology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Oncol. 2021 Oct 4;11:723669. doi: 10.3389/fonc.2021.723669. eCollection 2021.
As a research team of urologists and an anesthetist, we sought to investigate the prognostic significance of American Society of Anesthesiologists (ASA) score in patients with upper tract urothelial cancer (UTUC) after radical nephroureterectomy (RNU). ASA physical status (ASA-PS) classification not only was found to be associated with increased comorbidities but also independently factors for predicting morbidity and mortality. Accurate risk assessment was being particularly important for patients being considered for surgery.
Records for 958 patients with UTUC who underwent RNU were reviewed. Clinicopathologic variables, including ASA-PS, were assessed at two institutions. Overall survival (OS), cancer-specific survival (CSS), intravesical recurrence-free survival (IRFS), and metastasis-free survival (MFS) were estimated using the Kaplan-Meier method and Cox regression analyses. We measured the independent predictive value of ASA-PS for mortality by multivariate regression. Association of ASA-PS and clinicopathologic variables was assessed.
The group of patients with ASA = 2/3 had a shorter 5-year OS (67.6% and 49.9%), CSS (72.9% and 58.1%), and MFS (75.1% and 58.5%). The median follow-up time was 39 months. Kaplan-Meier curves showed that the group with ASA = 2/3 had significantly poorer OS, CSS, and MFS. Adjusting for multiple potential confounding factors, multivariate analyses suggested that ASA score was an independent predictor of OS, CSS, and MFS (p = 0.004, p = 0.005, p < 0.001).
Higher ASA scores were independently associated with lower survival rate. This capability, along with its simplicity, makes it a valuable prognostic metric. It should be seriously referenced in UTUC patients being considered for RNU.
作为一个由泌尿科医生和麻醉师组成的研究团队，我们试图研究美国麻醉医师协会（ASA）评分在根治性肾输尿管切除术（RNU）后上尿路尿路上皮癌（UTUC）患者中的预后意义。ASA身体状况（ASA-PS）分类不仅与合并症增加有关，而且是预测发病率和死亡率的独立因素。准确的风险评估对考虑手术的患者尤为重要。
回顾了958例行RNU的UTUC患者的记录。在两个机构评估了包括ASA-PS在内的临床病理变量。使用Kaplan-Meier方法和Cox回归分析估计总生存期（OS）、癌症特异性生存期（CSS）、膀胱内无复发生存期（IRFS）和无转移生存期（MFS）。我们通过多变量回归测量了ASA-PS对死亡率的独立预测价值。评估了ASA-PS与临床病理变量的相关性。
ASA=2/3组的5年总生存期（分别为67.6%和49.9%）、癌症特异性生存期（分别为72.9%和58.1%）和无转移生存期（分别为75.1%和58.5%）较短。中位随访时间为39个月。Kaplan-Meier曲线显示，ASA=2/3组的总生存期、癌症特异性生存期和无转移生存期明显较差。在调整了多个潜在混杂因素后，多变量分析表明ASA评分是总生存期、癌症特异性生存期和无转移生存期的独立预测因素（p=0.004，p=0.005，p<0.001）。
较高的ASA评分与较低的生存率独立相关。这种能力及其简单性使其成为一个有价值的预后指标。在考虑行RNU的UTUC患者中应认真参考。
