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- Title
A prognostic model for survival after palliative urinary diversion for malignant ureteric obstruction: a prospective study of 208 patients.
- Authors
Cordeiro, Maurício D.; Coelho, Rafael F.; Chade, Daher C.; Pessoa, Rodrigo R.; Chaib, Mateus S.; Colombo‐Júnior, José R.; Pontes‐Júnior, José; Guglielmetti, Giuliano B.; Srougi, Miguel
- Abstract
Objective To identify factors associated with survival after palliative urinary diversion ( UD) for patients with malignant ureteric obstruction ( MUO) and create a risk-stratification model for treatment decisions. Patients and Methods We prospectively collected clinical and laboratory data for patients who underwent palliative UD by ureteric stenting or percutaneous nephrostomy ( PCN) between 1 January 2009 and 1 November 2011 in two tertiary care university hospitals, with a minimum 6-month follow-up. Inclusion criteria were age >18 years and MUO confirmed by computed tomography, ultrasonography or magnetic resonance imaging. Factors related to poor prognosis were identified by Cox univariable and multivariable regression analyses, and a risk stratification model was created by Kaplan- Meier survival estimates at 1, 6 and 12 months, and log-rank tests. Results The median (range) survival was 144 (0-1084) days for the 208 patients included after UD (58 ureteric stenting, 150 PCN); 164 patients died, 44 (21.2%) during hospitalisation. Overall survival did not differ by UD type ( P = 0.216). The number of events related to malignancy (≥4) and Eastern Cooperative Oncology Group ( ECOG) index (≥2) were associated with short survival on multivariable analysis. These two risk factors were used to divide patients into three groups by survival type: favourable (no factors), intermediate (one factor) and unfavourable (two factors). The median survival at 1, 6, and 12 months was 94.4%, 57.3% and 44.9% in the favourable group; 78.0%, 36.3%, and 15.5% in the intermediate group; and 46.4%, 14.3%, and 7.1% in the unfavourable group ( P < 0.001). Conclusions Our stratification model may be useful to determine whether UD is indicated for patients with MUO.
- Subjects
URINARY diversion; URETERIC obstruction; NEPHROSTOMY; COMPUTED tomography; ULTRASONIC imaging; MAGNETIC resonance imaging; KAPLAN-Meier estimator
- Publication
BJU International, 2016, Vol 117, Issue 2, p266
- ISSN
1464-4096
- Publication type
Article
- DOI
10.1111/bju.12963