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
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