Aravantinos Evangelos, Anagnostou Theodore, Karatzas Anastasios D, Papakonstantinou Wassileios, Samarinas Michael, Melekos Michael D
Department of Urology, University of Thessaly, Larissa, Greece.
J Endourol. 2007 Nov;21(11):1297-302. doi: 10.1089/end.2006.0104.
The purpose of this study was to evaluate the outcome, in respect to safety, survival, and quality of life (QoL), after performance of percutaneous nephrostomy in patients with obstructive nephropathy caused by various types of advanced malignancy.
A cohort of 270 patients with established nephropathy because of advanced pelvic or nonpelvic tumors was evaluated. A decision to obtain percutaneous access was made; primary stenting had either failed or was not feasible because of complicated anatomy. Patients were divided in equal groups by type of malignancy (54 patients each). In addition, each malignancy group was further divided in two equal subgroups by tumor burden (27 patients each). Correlations were made with respect to renal function outcome, overall survival after the procedure, and QoL differences both before and after the procedure.
No serious complications, such as severe bleeding or sepsis, were experienced because of the procedure. Statistical analysis showed no significant differences in survival among patients with different types of cancer. Only patients with prostate (P < 0.0365) and colorectal (P < 0.0307) cancer with lower tumor burden had significantly longer survival when compared with patients with large tumor burden. Regarding QoL scores, only patients with prostate cancer in the subgroup with low tumor burden demonstrated a positive statistically significant difference (P < 0.001).
Despite the fact that percutaneous nephrostomy has shown good safety characteristics and beneficial impact on renal function, only patients with specific cancers most likely to respond to ongoing palliative therapy or with cancers that progress slowly by nature may statistically benefit from the procedure. This questions the universal application of this procedure for all types and stages of advanced malignancy.
本研究旨在评估各类晚期恶性肿瘤所致梗阻性肾病患者行肾造瘘术后的安全性、生存率及生活质量（QoL）。
对270例因晚期盆腔或非盆腔肿瘤导致肾病确诊的患者进行评估。决定采用经皮穿刺造瘘；由于解剖结构复杂，一期支架置入失败或不可行。根据恶性肿瘤类型将患者平均分组（每组54例）。此外，每个恶性肿瘤组再根据肿瘤负荷进一步平均分为两个亚组（每组27例）。分析肾造瘘术后肾功能转归、总体生存率及生活质量差异的相关性。
该操作未出现严重并发症，如严重出血或败血症。统计分析显示不同类型癌症患者的生存率无显著差异。仅肿瘤负荷较低的前列腺癌（P < 0.0365）和结直肠癌（P < 0.0307）患者与肿瘤负荷大的患者相比，生存期显著延长。关于生活质量评分，仅肿瘤负荷低的亚组中的前列腺癌患者有统计学意义的显著正向差异（P < 0.001）。
尽管经皮肾造瘘显示出良好的安全性及对肾功能的有益影响，但仅特定癌症患者（最有可能对持续姑息治疗有反应或本质上进展缓慢的癌症患者）可能从该操作中获得统计学意义上的益处。这对该操作在所有类型和阶段的晚期恶性肿瘤中的普遍应用提出了质疑。
