Article Text

Download PDFPDF
Hydronephrosis as a Prognostic Indicator of Survival in Advanced Cervix Cancer
  1. Tana S. Pradhan, DO*,
  2. Haiou Duan, MD,
  3. Evangelia Katsoulakis, MD,
  4. Ghadir Salame, MD*,
  5. Yi-Chun Lee, MD* and
  6. Ovadia Abulafia, MD*
  1. *Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,
  2. Department of Obstetrics and Gynecology, and
  3. Department of Radiation Oncology, State University of New York, Downstate Medical Center and Kings County Medical Center, Brooklyn, NY.
  1. Address correspondence and reprint requests to Tana S. Pradhan, DO, Gynecologic Oncology Fellow, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center and Kings County Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203. E-mail: tana.shah{at}downstate.edu.

Abstract

Objective: To determine whether hydronephrosis is an independent prognostic indicator of survival among patients with advanced cervical carcinoma. Moreover, we wanted to demonstrate the relationship between unilateral and bilateral hydronephrosis and overall survival.

Methods: Retrospective analysis of 197 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIB cervical carcinoma or higher treated between 1990 and 2007 was conducted. Inclusion criteria were clinical staging according to FIGO criteria, standardized radiation treatment and cisplatin-based chemosensitization regimens. Associations between hydronephrosis and covariates-age, race, histopathologic diagnosis, pelvic sidewall involvement, stage, nodal involvement, and Gynecologic Oncology Group/Eastern Cooperative Oncology Group performance status (PS)-were determined. Statistical analysis including Kaplan-Meier, log-rank test, proportional hazards regression, Fisher exact test, and Mann-Whitney test were used where appropriate, with P < 0.05 considered significant.

Results: Of 143 included patients, 73 patients had no hydronephrosis (HN), 39 patients had unilateral HN, and 31 patients had bilateral HN. Twenty-nine patients (40%) with no HN died compared to 24 patients (61.5%) with unilateral HN and 21 patients (67.7%) with bilateral HN. Median time to death was significantly shorter for patients with unilateral HN (27 months; 95% confidence interval [CI], 10-48) and bilateral HN (12 months; 95% CI, 6-23) versus patients without HN (68 months; 95% CI, 39-∞; P < 0.001). Unadjusted hazard ratio (HR) for HN (both unilateral and bilateral) was 2.4 (95% CI, 1.5-3.8); P < 0.001. Of potential covariates evaluated, PS and sidewall involvement were significantly associated with HN (P = 0.021 and P = 0.014, respectively). Proportional hazards regression revealed that controlling for use of radiation, chemotherapy, and for PS, HN was still significantly associated with poor prognosis (HR unilateral HN = 2.0, 95% CI, 1.2-3.5; HR bilateral HN = 3.2, 95% CI, 1.7-6.0); P ≤ 0.001.

Conclusion: Hydronephrosis is an independent poor prognostic indicator of survival in patients with advanced cervical cancer. Bilateral hydronephrosis compared to unilateral involvement confers a worse overall prognosis. Additional studies are needed to determine if FIGO staging should be amended.

  • Hydronephrosis
  • Cervical cancer
  • FIGO staging

Statistics from Altmetric.com

Footnotes

  • We have not received any pharmaceutical or industry support for this project that require acknowledgement.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.