TY - JOUR
T1 - Clinical value of cholinesterase in patients treated with radical nephroureterectomy for upper urinary tract carcinoma
AU - von Deimling, Markus
AU - D’Andrea, David
AU - Pradere, Benjamin
AU - Laukhtina, Ekaterina
AU - Yanagisawa, Takafumi
AU - Kawada, Tatsushi
AU - Majdoub, Muhammad
AU - Rajwa, Pawel
AU - Pallauf, Maximilian
AU - Singla, Nirmish
AU - Soria, Francesco
AU - Margulis, Vitaly
AU - Chlosta, Piotr
AU - Karakiewicz, Pierre I.
AU - Roupret, Morgan
AU - Teoh, Jeremy Yuen Chun
AU - Fisch, Margit
AU - Rink, Michael
AU - Moschini, Marco
AU - Lotan, Yair
AU - Shariat, Shahrokh F.
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/7
Y1 - 2023/7
N2 - 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.
AB - 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.
KW - Biomarker
KW - Cholinesterase
KW - Decision curve analysis
KW - Upper urinary tract urothelial carcinoma
KW - Urothelial neoplasm
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U2 - 10.1007/s00345-023-04449-1
DO - 10.1007/s00345-023-04449-1
M3 - Article
C2 - 37294372
AN - SCOPUS:85161384206
SN - 0724-4983
VL - 41
SP - 1861
EP - 1868
JO - World journal of urology
JF - World journal of urology
IS - 7
ER -