Urology, Christchurch Hospital, Christchurch, New Zealand.
BJU Int. 2009 Oct;104(7):938-41. doi: 10.1111/j.1464-410X.2009.08492.x. Epub 2009 Mar 26.
To validate a model to stratify patients with obstructive nephropathy due to malignant ureteric obstruction, associated with a poor prognosis, into different prognostic groups, as a recent report identified low serum albumin, degree of hydronephrosis and number of events related to metastatic disease as prognostic indicators before palliative decompression.
We retrospectively review the charts to identify all patients who had a nephrostomy tube inserted for malignant ureteric 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.
The 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).
Consistent 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.
验证一种模型，以将因恶性输尿管梗阻导致预后不良的梗阻性肾病患者分层为不同的预后组，因为最近的一份报告确定了低血清白蛋白、肾积水程度和与转移疾病相关的事件数量作为姑息性减压前的预后指标。
我们回顾性地查看了所有因恶性输尿管梗阻而插入肾造瘘管的患者的病历。回顾了可能影响预后的实验室和临床因素，试图对以前确定的因素和风险分层模型进行外部验证。
确定的 49 名患者的中位（范围）年龄为 71 岁（36-91 岁），中位生存期为 174 天（14-602 天）。66%的患者的肿瘤来源于泌尿系统。前列腺癌患者的肾造瘘管留置时间平均为 279 天，而非前列腺来源肿瘤患者为 190 天（P=0.07）。血清白蛋白水平>30g/L（P≤0.001）、血清钠<135mmol/L（P=0.019）和与癌症扩散相关的三个或更多事件（P=0.04）是与平均生存时间显著缩短相关的因素。39%的患者出现与肾造瘘管相关的并发症。该模型在将这些患者分层为不同的风险组方面非常有用（P=0.002）。
与之前的报告一致，我们发现低血清白蛋白水平和与转移疾病相关的事件表明预后不良。我们还发现低血清钠水平可能与预后较差相关。我们对外验证了一种将患者分层为不同预后组的模型。姑息性减压与显著的发病率相关。
