• Atiqullah Aziz, Hans-Martin Fritsche, Georgios Gakis, Luis A Kluth, Fahmy al-Sayed Hassan, Oliver Engel, Roland Dahlem, Wolfgang Otto, Michael Gierth, Stefan Denzinger, Christian Schwentner, Arnulf Stenzl, Shahrokh F Shariat, Margit Fisch, Maximilian Burger, and Michael Rink.
• Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
• Urol. Oncol. 2014 Nov 1; 32 (8): 1141-50.

ObjectiveComorbidity and performance indices (CPIs) are useful tools to evaluate patient's risk of comorbidities and thus may guide clinical decision making regarding surgery or multimodal therapy approaches. Hence, the aim of the current study was to assess the predictive capacity of CPIs comprising the American Society of Anaesthesiologists (ASA)-score, the Charlson comorbidity index (CCI), the age-adjusted CCI (ACCI), and the Eastern Cooperative Oncology Group performance status (ECOG-PS) in patients with upper tract urothelial carcinoma (UTUC) who were treated with radical nephroureterectomy (RNU).Methods And MaterialsA total of 242 patients with UTUC underwent RNU without neoadjuvant chemotherapy between 1992 and 2012 at 3 German academic centers. Patients were stratified according to the pre-RNU CPIs dichotomized as ASA 1/2 vs .≥ 3, CCI 0 to 2 vs. > 2, ACCI 0 to 5 vs. > 5, and ECOG-PS 0 to 1 vs. > 1. We assessed the associations of CPIs with clinicopathologic features, as well as the prognostic effect on recurrence-free survival, cancer-specific survival (CSS), overall survival, and cancer-independent mortality (CIM), using univariable and multivariable Cox regression analyses.ResultsSixty-two patients (25.6%) had an ASA-score ≥ 3, 71 patients (29.3%) a CCI>2, 50 patients (20.7%) an ACCI > 5, and 122 (50.4%) patients an ECOG-PS > 1. The ASA-score (P = 0.001), CCI (P = 0.029), and the ECOG-PS (P < 0.001) were significantly associated with age. In addition, the ECOG-PS was associated with pelvicalyceal tumors (P = 0.012), and the CCI with preoperative hydronephrosis (P = 0.026). The median follow-up was 30 months. In Kaplan-Meier analyses, ACCI > 5 (P ≤ 0.025) and ECOG-PS > 1 (P ≤ 0.042) were associated with recurrence-free survival, CSS, and overall survival, and ASA-score ≥ 3 (P = 0.011) and ACCI > 5 (P = 0.006) with CIM. In multivariable analysis that adjusted for standard clinicopathologic parameters, an ECOG-PS > 1 was an independent predictor for CSS (hazard ratio = 1.89, P = 0.019), and an ASA-score ≥ 3 (hazard ratio = 1.86, P = 0.026) was a predictor for CIM.ConclusionCPIs are easy assessable predictors for outcome in patients with UTUC who were treated with RNU. CPIs have carefully to be taken into account in patient counseling regarding operative decision making and multimodal treatment.Copyright © 2014 Elsevier Inc. All rights reserved.

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