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. 2022 Mar 12;14(6):1466.
doi: 10.3390/cancers14061466.

Prognostic Value of Comorbidity for Patients with Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy

Hung-Lung Ke  1   2   3   4 , Ching-Chia Li  1   2 , Hsiang-Ying Lee  1   2 , Hung-Pin Tu  5 , Yu-Ching Wei  6   7 , Hsin-Chih Yeh  1   2   3   4 , Wen-Jeng Wu  1   2   3   8 , Wei-Ming Li  1   2   8   9
Affiliations

Prognostic Value of Comorbidity for Patients with Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy

Hung-Lung Ke et al. Cancers (Basel). .

Abstract

Patients with upper tract urothelial carcinoma (UTUC) have a high prevalence of comorbidities. However, the prognostic impact of comorbidities in these patients is not well studied. We aimed to outline the comorbidity burden in UTUC patients and investigate its relationship with overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). We retrospectively reviewed the clinicopathological data of 409 non-metastatic UTUC patients who received radical nephroureterectomy between 2000 and 2015. The comorbidity burden was evaluated using the Adult Comorbidity Evaluation-27 (ACE-27). Kaplan-Meier survival analysis showed that high ACE-27 grade was significantly associated with worse PFS, CSS, and OS. In multivariate Cox regression and competing risk analyses, we found that ACE-27 grade, tumor stage, and tumor grade were independent prognosticators of OS, CSS, and PFS. We combined these three significant factors to construct a prognostic model for predicting clinical outcomes. A receiver operating characteristic curve revealed that our prognostic model had high predictive performance. The Harrel's concordance indices of this model for predicting OS, CSS, and PFS were 0.81, 0.85, and 0.85, respectively. The results suggest that the UTUC patient comorbidity burden (ACE-27) provides information on the risk for meaningful clinical outcomes of OS, CSS, and PFS.

Keywords: Adult Comorbidity Evaluation-27; comorbidity; prognosis; upper tract urothelial carcinoma.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier survival curves of progression-free survival (A); cancer-specific survival (B) and overall survival (C) according to the ACE-27 score: 0, none; 1, mild; 2, moderate; 3, severe.
Figure 2
Figure 2
Cumulative incidence function for cancer progression (A) and cancer-specific death (B) according to the ACE-27 score: 0, none; 1, mild; 2, moderate; 3, severe.
Figure 3
Figure 3
Receiver operator characteristic (ROC) analysis of seven models for predicting progression-free survival (A); cancer-specific survival (B) and overall survival (C) at five years.
Figure 4
Figure 4
The integrated time-dependent AUC for progression-free survival (A); cancer-specific survival (B) and overall survival (C).
See this image and copyright information in PMC

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