Prognostic factors in malignant ureteric obstruction

Abstract

obstruction. Laboratory and clinical factors that might influence prognosis were reviewed to attempt to externally validate the previously identified factors and model for risk stratification. RESULTSThe median (range) age of the 49 patients identified was 71 (36-91) years, and the median survival was 174 (14-602) days. Tumours were of urological origin in 66% of patients. Patients with prostate cancer had nephrostomy tubes indwelling for a mean of 279 days, vs 190 days ( P = 0.07) for patients with tumours not of prostatic origin. A serum albumin level of > 30 g/L ( P ≤ 0.001), serum sodium < 135 mmol/L ( P = 0.019) and three or more events related to dissemination of cancer ( P = 0.04) were factors associated with a significantly shorter mean survival. Complications related to the nephrostomy tube were experienced by 39% of patients. The model proved useful in stratifying these patients into different risk groups ( P = 0.002). CONCLUSIONConsistent with a previous report we showed that a low serum albumin level and events related to metastatic disease were indicative of a poor prognosis. We also found that a low serum sodium level might be associated with a worse prognosis. We externally validated a model for stratifying patients into different prognostic groups. Palliative decompression is associated with significant morbidity. KEYWORDS

Renal and urologic problems

“…In addition to validating Ishioka et al's risk-stratification model the authors found that low serum sodium levels are also associated with a poor prognosis. Longer median survival times were noted in patients with prostate cancer [1].…”

“…Determining the cause of obstruction is also helpful in determining a patient's prognosis. For example, tumours that originate outside the pelvis have a worse prognosis [1].…”

“…On the basis of these findings ureteral stenting and nephrostomy tubes may not be indicated in poorrisk patients [2]. The prognostic stratification model has been validated in a retrospective study by Lienert et al [1] who found that patients in the favourable-risk group (no risk factors) had a mean survival of 278 vs. 173 days for the intermediate-risk group (one risk factor) and 63 days for those in the high-risk group (two or three risk factors). In addition to validating Ishioka et al's risk-stratification model the authors found that low serum sodium levels are also associated with a poor prognosis.…”

“…These include low serum albumin or sodium levels, the degree of hydronephrosis and three or more events related to malignant dissemination of the primary tumour [2]. Tumours originating outside the pelvis have a poorer prognosis, whereas patients with prostate and gynaecological cancers have better median survival times [1,4]. There is no clear evidence that urinary diversion improves QoL and treatment decisions must be individualized [4].…”

“…Criteria to stratify risk of failure/success of urinary diversion in patients with malignant obstructive nephropathy (low-risk group, 0 risk factor; intermediate-risk group, 1 risk factor; poor-risk group, 2 or 3 risk factors) [1,2]:…”