Age and ECOG Performance Status as Predictors of Survival of Patients with Upper Urinary Tract Urothelial Carcinoma Undergoing Radical Nephroureterectomy

Abstract

<b><i>Introduction:</i></b> This study aimed to evaluate the impact of chronological and biological age on perioperative complications and survival after radical nephroureterectomy (RNU). Elderly patients with upper-tract urothelial carcinoma might be overtreated by RNU. <b><i>Methods:</i></b> We retrospectively analyzed patients undergoing RNU. To evaluate the perioperative risk, patients were divided into four groups (&#x3c;75; 75–79; 80–84; ≥85 years). The endpoints are perioperative complications and survival (overall survival [OS]). We calculated a risk score including chronological and biological age (Eastern cooperative oncology group performance status). Statistical analysis was performed by Kruskal-Wallis, Mann-Whitney U, χ², log-rank, and Breslow tests. <b><i>Results:</i></b> 194 patients were included in the study. Median follow-up was 25.5 months. Elderly cohorts ≥2 presented a higher number of days in intensive care unit following RNU (<i>p</i> &#x3c; 0.001). Complication rates increased from cohort 1–4 with rates of 48.8%; 55.2%; 92.0%; 85.7% (<i>p</i> &#x3c; 0.001). Median survival was 115, 55, 28, and 20 months for cohorts 1, 2, 3, and 4, respectively. The combined risk score revealed a significant 5-year OS benefit for patients with score 0 (82.3%) compared to score 1 (46.0%) and score 2 (15.0%; <i>p</i> &#x3c; 0.001). <b><i>Discussion/Conclusion:</i></b> We evaluated the impact of chronological and biological age on perioperative complications and survival after RNU. A combined risk score of chronological and biological age correlates with survival after RNU.