Prognostic role of ECOG performance status in patients with urothelial carcinoma of the upper urinary tract: an international study
Article first published online: 24 AUG 2011
© 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL
Volume 109, Issue 8, pages 1155–1161, April 2012
How to Cite
Martinez-Salamanca, J. I., Shariat, S. F., Rodriguez, J. C., Chromecki, T. F., Ficarra, V., Fritsche, H.-M., Kassouf, W., Matsumoto, K., Cabello, L. O., Seitz, C., Tritschler, S., Walton, T. J., Zattoni, F. and Novara, G. (2012), Prognostic role of ECOG performance status in patients with urothelial carcinoma of the upper urinary tract: an international study. BJU International, 109: 1155–1161. doi: 10.1111/j.1464-410X.2011.10479.x
- Issue published online: 27 MAR 2012
- Article first published online: 24 AUG 2011
- Accepted for publication 29 April 2011
- performance status;
- urinary tract cancer;
- urothelial carcinoma;
- recurrence-free survival;
- cancer-specific mortality
Study Type – Prognosis (inception cohort series)
Level of Evidence 2a
What's known on the subject? and What does the study add?
ECOG Performance Status has gained wide popularity as an integral part of the assessment of patients with upper urinary tract carcinoma. Our findings indicate that ECOG-PS is strongly associated with perioperative and overall survival and should be considered carefully in our decision-making process.
- • To evaluate the prognostic role of ECOG Performance status (ECOG-PS) in a large multi-institutional international cohort of patients treated with radical nephroureterectomy for upper tract urothelial carcinoma.
MATERIALS AND METHODS
- • Data of 427 patients treated with radical nephroureterectomy at five international institutions in Asia, Europe and Northern America were collected retrospectively from 1987 to 2008.
- • Logistic and Cox regression models were used for univariable and multivariable analyses.
- • ECOG-PS was 0 in 272 of 427 (64%) patients. The median follow-up of the whole cohort was 32 months.
- • The five-year recurrence-free (RFS), cancer-specific (CSS) and overall (OS) survival estimates were 71.7%, 74.9% and 68.5%, respectively, in patients with ECOG-PS 0 compared with 60.1%, 67.8%, and 51.4% respectively, in patients with ECOG-PS ≥1 (P value 0.08 for RFS, 0.43 for CSS, and <0.001 for OS, respectively).
- • On multivariable Cox regression analyses, ECOG-PS was not an independent predictor of either RFS (hazard ratio 1.4; P = 0.107) or CSS (hazard ratio 1.2; P = 0.426) but was an independent predictor of OS (hazard ratio 1.5; P = 0.03).
- • In this large multicentre international study, ECOG-PS was not significantly associated with RFS and CSS.
- • Conversely we find a strong association with survival 1-month after surgery and OS. Further research is needed to ascertain the additive prognostic role of ECOG-PS in well-designed prospective multicentre studies.