Effect of Hydronephrosis on Survival in Advanced Stage Cervical Cancer

Abstract

Background: Hydronephrosis is frequently encountered in advanced stage cervical cancers, and may be associated with mortality. In the present study, we aimed to demonstrate the effect of hydronephrosis on survival in patients with inoperable advanced stage cervical cancer. Materials and Methods: The study data were acquired by retrospective analysis of the patient records belonging to 165 women with FIGO (International Federation of Gynecology and Obstetrics) stage-IIIB or more advanced cervical cancer, which were not surgical candidates. Parameters including patient age, pathological diagnosis, disease stage, pelvic sidewall extension, presence of hydronephrosis and administration of chemoradiation were analyzed. Further, the effects of these variables on survival were assessed. P values less than 0.05 were considered statistically significant. Results: The distribution of the study patients according to disease stage was as follows: 131 (79.4%) had stage-IIIB, 18 (10.9%) had stage-IVB and 16 (% 9.7) patients had stage-IVA disease. Hydronephrosis was not evident in 91 (55.2%) of these patients, whereas 41 (24.8%) had unilateral and 33 (20%) patients had bilateral hydronephrosis. When compared to mean survival in patients who did not have hydronephrosis, survival was significantly shortened in patients who had bilateral and unilateral hydronephrosis (p < 0.05). There was no significant survival difference between patients with unilateral and bilateral hydronephrosis (p>0.05). Although patient age, pathological type, pelvic involvement, and chemotherapy treatment rates were similar (p>0.05), radiotherapy requirement rate and disease stage were significantly different among the study groups (p<0.05). Conclusions: Hydronephrosis was found to be a significant predictor of poor survival in patients with advanced stage cervical cancer, irrespective of unilateral or bilateral involvement.While waiting for future studies with larger sample sizes, we believe that the FIGO stages in advanced cervical cancer could further be stratified into subgroups according to presence or absence of hydronephrosis.

Prognosis of Hydronephrosis in Cervical Cancer at the Libreville Cancer Institute

“…Their 3-year survival rates were 37% and 74%, respectively, for those with and without UHN (p=0.002). These results are also similar to a study by Goklu et al [11] which showed that for patients with hydronephrosis, the mean survival was significantly shortened (p<0.05). However, there was no significant difference in survival between patients with bilateral and unilateral hydronephrosis (p>0.05).…”

“…The prevalence of urological complications was 45.9% in the present study, close to the 48.8% found by Atuhairwes et al [3]. Similarly, Lee et al [10] and Gloku et al [11] reported prevalences of urological complications of 55.8% and 44.8%, respectively. The high proportion of urological complications such as hydronephrosis is due to our study's high proportion of advanced stages.…”

“…However, there was no significant difference in survival between patients with bilateral and unilateral hydronephrosis (p>0.05). Hydronephrosis has been identified as a predictor of poor survival in patients with cervical cancer [11]. In the study by Pradhan et al [13] of 143 cervical cancer patients, 39 (27%) had unilateral hydronephrosis, and 31 (21.6%) had bilateral hydronephrosis.…”

Survival outcomes of patients with cervical cancer and accompanying hydronephrosis: A systematic review of the literature

“…The severity of hydronephrosis and its impact on overall survival was not evaluated among the included articles, however, Goklu et al observed that the mean survival of patients with unilateral hydronephrosis was significantly larger compared to that of patients with bilateral hydronephrosis (42.2 vs 29.9 months). 18 Patel et al reported that the most prominent symptom of hydronephrosis was urinary tract infection (9 out of 17 patients), accompanied by pain (8 out of 17 patients). 17 In their series they observed that 7 patients developed renal failure with creatinine levels that ranged between 1.7 and 5.6 mg/dL.…”

Incorporation of whole pelvic radiation into treatment of stage IVB cervical cancer: A novel treatment strategy

“…While these issues undoubtedly adversely affect quality of life, they also may be negatively correlated with survival. For example, two retrospective studies have demonstrated poorer OS among patients with stage IIIB-IVB cervical cancer and hydronephrosis at the time of diagnosis [5,6]. Higher symptom burdens in these women may also negatively impact their disease course.…”