Clinical value of cholinesterase in patients treated with radical nephroureterectomy for upper urinary tract carcinoma

  • Markus von Deimling (Geteilte/r Erstautor/in)
  • David D'Andrea (Geteilte/r Erstautor/in)
  • Benjamin Pradere
  • Ekaterina Laukhtina
  • Takafumi Yanagisawa
  • Tatsushi Kawada
  • Muhammad Majdoub
  • Pawel Rajwa
  • Maximilian Pallauf
  • Nirmish Singla
  • Francesco Soria
  • Vitaly Margulis
  • Piotr Chlosta
  • Pierre I Karakiewicz
  • Morgan Roupret
  • Jeremy Yuen-Chun Teoh
  • Margit Fisch
  • Michael Rink
  • Marco Moschini
  • Yair Lotan
  • Shahrokh F Shariat

Beteiligte Einrichtungen

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.

Bibliografische Daten

OriginalspracheEnglisch
ISSN0724-4983
DOIs
StatusVeröffentlicht - 07.2023