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- Title
Clinical value of cholinesterase in patients treated with radical nephroureterectomy for upper urinary tract carcinoma.
- Authors
von Deimling, Markus; D'Andrea, David; Pradere, Benjamin; Laukhtina, Ekaterina; Yanagisawa, Takafumi; Kawada, Tatsushi; Majdoub, Muhammad; Rajwa, Pawel; Pallauf, Maximilian; Singla, Nirmish; Soria, Francesco; Margulis, Vitaly; Chlosta, Piotr; Karakiewicz, Pierre I.; Roupret, Morgan; Teoh, Jeremy Yuen-Chun; Fisch, Margit; Rink, Michael; Moschini, Marco; Lotan, Yair
- Abstract
Purpose: To evaluate the prognostic value and the clinical impact of preoperative serum cholinesterase (ChoE) levels on decision-making in patients treated with radical nephroureterectomy (RNU) for clinically non-metastatic upper tract urothelial cancer (UTUC). Methods: A retrospective review of an established multi-institutional UTUC database was performed. We evaluated preoperative ChoE as a continuous and dichotomized variable using a visual assessment of the functional form of the association of ChoE with cancer-specific survival (CSS). We used univariable and multivariable Cox regression models to establish its association with recurrence-free survival (RFS), CSS, and overall survival (OS). Discrimination was evaluated using Harrell's concordance index. Decision curve analysis (DCA) was used to assess the impact on clinical decision-making of preoperative ChoE. Results: A total of 748 patients were available for analysis. Within a median follow-up of 34 months (IQR 15–64), 191 patients experienced disease recurrence, and 257 died, with 165 dying of UTUC. The optimal ChoE cutoff identified was 5.8 U/l. ChoE as continuous variable was significantly associated with RFS (p < 0.001), OS (p < 0.001), and CSS (p < 0.001) on univariable and multivariable analyses. The concordance index improved by 8%, 4.4%, and 7% for RFS, OS, and CSS, respectively. On DCA, including ChoE did not improve the net benefit of standard prognostic models. Conclusion: Despite its independent association with RFS, OS, and CSS, preoperative serum ChoE has no impact on clinical decision-making. In future studies, ChoE should be investigated as part of the tumor microenvironment and assessed as part of predictive and prognostic models, specifically in the setting of immune checkpoint-inhibitor therapy.
- Subjects
URINARY organs; PROGNOSTIC models; DECISION making; TRANSITIONAL cell carcinoma; PROGNOSIS
- Publication
World Journal of Urology, 2023, Vol 41, Issue 7, p1861
- ISSN
0724-4983
- Publication type
Article
- DOI
10.1007/s00345-023-04449-1