Ramy F Youssef1, Laura-Maria Krabbe2, Shahrokh F Shariat3, Yair Lotan4, Arthur I Sagalowsky4, Jay Raman5, Christopher G Wood6, Alon Weizer7, Marco Roscigno8, Francesco Montorsi9, Christian Bolenz10, Mesut Remzi11, Karim Bensalah12, Wassim Kassouf13, Vitaly Margulis14. 1. University of California, Irvine, Orange, CA, USA. ramy.yaacoub@utsouthwestern.edu. 2. University of Muenster Medical Center, Muenster, Germany. 3. Vienna General Hospital, Medical University of Vienna, Vienna, Austria. 4. UT Southwestern Medical Center, Dallas, TX, USA. 5. Penn State Milton S. Hershey Medical Center, Hershey, PA, USA. 6. UT M.D. Anderson Cancer Center, Houston, TX, USA. 7. University of Michigan, Ann Arbor, MI, USA. 8. AO Papa Giovanni XXIII, Bergamo, Italy. 9. Vita Salute University, San Raffaele, Milan, Italy. 10. Mannheim Medical Center, University of Heidelberg, Mannheim, Germany. 11. Landesklinikum Korneuburg, Korneuburg, Austria. 12. Bicêtre University Hospital, Le Kremlin Bicêtre, France. 13. McGill University Health Center, Montreal, QC, Canada. 14. UT Southwestern Medical Center, Dallas, TX, USA. Vitaly.Margulis@utsouthwestern.edu.
Abstract
PURPOSE: We created a prognostic tool for the prediction of oncologic outcomes after radical nephroureterectomy (RNU) for high-grade non-metastatic upper tract urothelial carcinoma (UTUC). METHODS: UTUC collaboration was utilized to include 586 patients who underwent RNU for non-metastatic high-grade UTUC. Survival outcomes were compared according to a score defined based on the sum of the independent prognostic variables. RESULTS: The study included 382 males with a median age 70 years (range 28-97). Independent prognostic factors included: T (t stage), A (architecture), LVI (lympho-vascular invasion) and L (lymphadenectomy). TALL score (1-7) was the sum of T (≤T1 = 1, T2 = 2, T3 = 3 and T4 = 4), A (papillary = 0 and sessile = 1), LVI (absent = 0 and present = 1) and L (lymphadenectomy = 0 and no lymphadenectomy = 1). Five-year disease-free survival (DFS) and cancer-specific survival (CSS) were stratified into four risk categories according to the TALL score: low (TALL 0-2; 86 % DFS and 90 % CSS), intermediate (TALL = 3; 71 % DFS and 75 % CSS), high (TALL = 4; 57 % DFS and 58 % CSS) and very high risk (TALL ≥ 5; 34 % DFS and 38 % CSS) using Kaplan-Meier survival analyses. TALL score was externally validated in a single-center cohort of 85 UTUC patients. CONCLUSIONS: We developed a multivariable prognostic tool for the prediction of oncological outcomes after RNU for high-grade UTUC. The score can be used for patient counseling, selection for adjuvant systemic therapies and design of clinical trials.
PURPOSE: We created a prognostic tool for the prediction of oncologic outcomes after radical nephroureterectomy (RNU) for high-grade non-metastatic upper tract urothelial carcinoma (UTUC). METHODS: UTUC collaboration was utilized to include 586 patients who underwent RNU for non-metastatic high-grade UTUC. Survival outcomes were compared according to a score defined based on the sum of the independent prognostic variables. RESULTS: The study included 382 males with a median age 70 years (range 28-97). Independent prognostic factors included: T (t stage), A (architecture), LVI (lympho-vascular invasion) and L (lymphadenectomy). TALL score (1-7) was the sum of T (≤T1 = 1, T2 = 2, T3 = 3 and T4 = 4), A (papillary = 0 and sessile = 1), LVI (absent = 0 and present = 1) and L (lymphadenectomy = 0 and no lymphadenectomy = 1). Five-year disease-free survival (DFS) and cancer-specific survival (CSS) were stratified into four risk categories according to the TALL score: low (TALL 0-2; 86 % DFS and 90 % CSS), intermediate (TALL = 3; 71 % DFS and 75 % CSS), high (TALL = 4; 57 % DFS and 58 % CSS) and very high risk (TALL ≥ 5; 34 % DFS and 38 % CSS) using Kaplan-Meier survival analyses. TALL score was externally validated in a single-center cohort of 85 UTUC patients. CONCLUSIONS: We developed a multivariable prognostic tool for the prediction of oncological outcomes after RNU for high-grade UTUC. The score can be used for patient counseling, selection for adjuvant systemic therapies and design of clinical trials.
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