Objective: To determine the prognostic value of
the American Society of Anesthesiologists (ASA) classification and of the main
clinical pathologic variables in renal cell carcinoma (RCC) patients who
underwent surgical treatment. Methods: In this international collaborative study, 376 RCC patients who
underwent partial nephrectomy (PN) or radical nephrectomy (RN) during the
were assessed. The pathological data were reviewed by a single pathologist, and
all of the surgically treated patients had been previously evaluated by a team
of anesthesiologists and classified as ASA 1, ASA 2, or ASA 3. Results: In total, 318
patients were included in the study, with a mean followup of 48 months.
Incidental tumors represented 47% of the cases, while 11.6% presented with
metastases at diagnosis. Among the patients assessed, 38 (11.9%) were
classified as ASA 1, 213 (67%) as ASA 2, and 67 (21.1%) as ASA 3. An
association between the ASA classification and the main clinicopathological
variables of RCC was observed. The univariate analysis for overall survival
(OS) revealed significant differences in the survival curves according to the ASA
classification (p < 0.001). High-grade neoplasms, the presence of metastasis
at diagnosis, clinical stage III/IV, and incidental tumors remained as
independent predictors of survival. Moreover, the multivariate analysis
revealed a negative impact of the ASA classification on OS (p = 0.001). Conclusions: The present
study demonstrated a correlation between the ASA classification and the main
prognostic factors of RCC and its impact on survival rates. ASA 3 patients had
more aggressive tumors, increased risk of perioperative complications, and
worse outcomes compared with ASA1 or ASA 2. Thus, the ASA classification may be
considered an additional tool for assessing and planning the treatment of RCC
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