Introduction

Chronological age is an important factor in in determining the treatment option and clinical response of patients with upper-tract urothelial carcinoma (UTUC). Much evidence suggests that chronological age alone is an inadequate indicator to predict the clinical response to radical nephroureterecyomy (RNU). On the other hand, prognostic impact of biological age has not been reported previously. Defining the biological age consists of the determination of a number of biological age markers including telomeres, chromatin, and some blood sampling data which is commonly measured in clinical practice. Therefore, the aim of our study was the validation of the prognostic significance of biological age related factors in a large cohort of UTUC patients.

Methods

We retrospectively reviewed the data from 1349 patients with localized UTUC (Ta-4N0M0) treated by RNU. WBC, NLR, Hb, PLT, CRP, Alb, ALP, LDH, Cr, corrected Ca were tested by the Spearman correlation to indicate the direction of association to chronological age. The test yielded significant, negative associations of Hb (P<0.001) and WBC (P=0.010) with chronological age. Hb (g/dl) and WBC (counts/?l) were analyzed to compare the 10-year cancer-specific survival (CSS) by Cox regression analysis as categorical variables (>14, 13-13.9, 12-12.9, 11-11.9, and <11), and (9200-8500, 8499-6000, 5999-4500, 4499-3200, <3200, and >9200), respectively. To establish the scoring system, we assigned points for these categories, and then correlated the total points to predicted probability of the surviving outcome as follows; point &[Prime]0&[Prime] for Hb >14 (reference) and 13-13.9 (OR: 1.533), point &[Prime]1&[Prime] for 12-12.9 (OR: 2.391), point &[Prime]2&[Prime] for 11-11.9 (OR: 3.015), and point &[Prime]3&[Prime] for <11 (OR: 3.584). For WBC, point &[Prime]1&[Prime] was assigned for >9200 (OR: 2.541) and &[Prime]0&[Prime] was assigned for the rest; 9200-8500 (reference), 8499-6000 (OR: 0.873), 5999-4500 (OR: 0.772), 4499-3200 (OR: 0.486), and <3200 (OR: 1.277).

Results

10-year CSS in higher risk group with score 4 or larger in age<60 was worse than score-0, or 1 in age >80 (mean estimated survival 69.7 months, CI: 33.3-106 v.s. 103.5. CI: 91-115.9). Concordance index between biological age scoring and chronological age was 0.704 for CSS and 0.798 for recurrence-free survival.

Conclusions

The biological age scoring developed for patients with UTUC undergoing RNU. It was applicable to those with localized disease, and performed well in diverse age populations

Funding

none