Article Text

Download PDFPDF
EP1053 Palliative urinary diversion in patients with malignant ureteric obstruction due to gynecologic cancer
  1. T Perri1,2,
  2. E Meller2,
  3. G Ben-Baruch1,2,
  4. Y Inbar2,3,
  5. S Apter2,3,
  6. L Heyman2,
  7. Z Dotan2,4 and
  8. J Korach1,2
  1. 1Gynecologic Oncology, Sheba Medical Center, Ramat Gan
  2. 2Sackler Faculty of Medicine, Ramat-Aviv
  3. 3Diagnostic Imaging
  4. 4Urology, Sheba Medical Center, Ramat Gan, Israel

Abstract

Introduction/Background We aimed to identify factors aiding selection gynecologic cancer patients with malignant urinary obstruction that are least likely to benefit from palliative urinary diversion (UD), and to create a risk-stratification model for decision-making.

Methodology This historic cohort study comprised 74 consecutive patients with urinary obstruction resulting from gynecologic malignancies. All underwent palliative UD by percutaneous nephrostomy (PCN). Using the Cox proportional-hazards regression model and Kaplan-Meier curves with the log-rank test, we developed a prognostic score identifying candidates least likely to benefit from the intervention.

Results Median follow-up was 4.72 (range 0−5.71) years. Hydronephrosis was diagnosed in most patients upon recurrent or persistent disease (81%). It was bilateral in 37.8%. Intervention-related complications included urinary sepsis (8%), catheter dislodgment requiring replacement (17%), and gross hematuria necessitating blood transfusions (13%). After PCN, conversion to an internal ureteral stent was feasible in 46%. Median survival was 11.13 (range 0–67) months. Two patients died within a month of UD. Multivariate analysis identified diabetes mellitus (DM), poor ECOG performance status >1, and ascites as significant negative survival factors. A prognostic index based on those factors identified the short-term and long-term survivors. Risk-factor-based mortality hazard ratios were 11.37 (95% CI, 4.12−31.37) with one factor, 26.57 (95% CI, 9.14−77.26) with two, and 67.25 (95% CI, 15.6−289.63) with three (all with p<0.0001).

Conclusion Our proposed prognostic index, based on ascites, ECOG performance status and DM, might help select gynecologic cancer patients least likely to benefit from palliative UD.

Disclosure Nothing to disclose

Statistics from Altmetric.com

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.