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Kang and Kim: The Author's Response: ASA Physical Status Classification in Surgical Oncology and the Importance of Improving Inter-Rater Reliability
Correspondence

Journal of Korean Medical Science 2017; 32(7): 1213.

Published online: 26 May 2017

DOI: https://doi.org/10.3346/jkms.2017.32.7.1213

The Author's Response: ASA Physical Status Classification in Surgical Oncology and the Importance of Improving Inter-Rater Reliability

Ho Won Kang, Wun-Jae Kim

Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.

Address for Correspondence: Wun-Jae Kim, MD, PhD. Department of Urology, Chungbuk National University, College of Medicine and Institute for Tumor Research, 776 1sunhwan-ro, Seowon-gu, Cheongju 28644, Republic of Korea. wjkim@chungbuk.ac.kr

© 2017 The Korean Academy of Medical Sciences.

The Korean Academy of Medical Sciences

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
We appreciate for a valuable comment by Araujo and Theobald. Numerous studies have been supported the prognostic role of comorbidity/performance indices in many cancer including urological malignancies such as prostate, bladder, and renal cell carcinoma (123).
We also concede that other comorbidity indices such as Charlson comorbidity index (CCI), Adult Comorbidity Evaluation-27 (ACE-27), Eastern Cooperative Oncology Group performance status (ECOG-PS), and Karnofsky performance status (KPS) are more appropriate for decision of chemotherapy eligibility and prediction of cancer related survival than American Society of Anesthesiologists physical status (ASA-PS) (4).
Previous frontier study by Berod et al. (5) showed the correlation between ASA classification and cancer-specific survival (CSS) after radical nephroureterectomy (RNU) in upper tract urothelial carcinoma (UTUC) patients. Without doubt, the aim of our study is not to evaluate the application of ASA-PS in decision on chemotherapy eligibility, but to explore the background of prognostic value of ASA-PS in UTUC patients after RNU.
Although no significant survival impact of ASA-PS score on overall survival (OS) or CSS in patients with localized UTUC was observed in subgroup analysis, high ASA-PS groups with locally advanced disease probably reflects a worse physical status directly related to the cancer itself as your comment (6).
Unfortunately, our multi-institutional data did not include any information about PS and we could not adequately adjust for PS. Further co-operated study is needed to clarify the relationship among ASA-PS and cancer related survival in UTUC patients after RNU.

References

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2. Santos Arrontes D, Fernández Aceñero MJ, García González JI, Martín Muñoz M, Paniagua Andrés P. Survival analysis of clear cell renal carcinoma according to the Charlson comorbidity index. J Urol. 2008; 179:857–861.
3. Boorjian SA, Kim SP, Tollefson MK, Carrasco A, Cheville JC, Thompson RH, Thapa P, Frank I. Comparative performance of comorbidity indices for estimating perioperative and 5-year all cause mortality following radical cystectomy for bladder cancer. J Urol. 2013; 190:55–60.
4. Hall SF. A user’s guide to selecting a comorbidity index for clinical research. J Clin Epidemiol. 2006; 59:849–855.
5. Berod AA, Colin P, Yates DR, Ouzzane A, Audouin M, Adam E, Arroua F, Marchand C, Bigot P, Soulié M, et al. The role of American Society of Anesthesiologists scores in predicting urothelial carcinoma of the upper urinary tract outcome after radical nephroureterectomy: results from a national multi-institutional collaborative study. BJU Int. 2012; 110:E1035–E1040.
6. Kang HW, Seo SP, Kim WT, Kim YJ, Yun SJ, Lee SC, Choi YD, Ha YS, Kim TH, Kwon TG, et al. Impact of the ASA physical status score on adjuvant chemotherapy eligibility and survival of upper tract urothelial carcinoma patients: a multicenter study. J Korean Med Sci. 2017; 32:335–342.
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ORCID iDs

Ho Won Kang
https://orcid.org/0000-0002-8164-4427

Wun-Jae Kim
https://orcid.org/0000-0002-8060-8926

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