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
Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil.
BJU Int. 2016 Feb;117(2):266-71. doi: 10.1111/bju.12963. Epub 2015 May 24.
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.
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.
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).
Our stratification model may be useful to determine whether UD is indicated for patients with MUO.
确定恶性输尿管梗阻（MUO）患者姑息性尿流改道（UD）后与生存相关的因素，并创建一个风险分层模型以用于治疗决策。
我们前瞻性收集了2009年1月1日至2011年11月1日期间在两家三级医疗大学医院接受输尿管支架置入术或经皮肾造瘘术（PCN）进行姑息性UD患者的临床和实验室数据，随访时间至少6个月。纳入标准为年龄>18岁且经计算机断层扫描、超声或磁共振成像确诊为MUO。通过Cox单变量和多变量回归分析确定与预后不良相关的因素，并通过Kaplan-Meier生存估计在1、6和12个月时以及对数秩检验创建风险分层模型。
208例接受UD后的患者（58例行输尿管支架置入术，150例行PCN）的中位（范围）生存时间为144（0 - 1084）天；164例患者死亡，44例（21.2%）在住院期间死亡。总体生存情况在UD类型之间无差异（P = 0.216）。多变量分析显示，与恶性肿瘤相关的事件数量（≥4）和东部肿瘤协作组（ECOG）指数（≥2）与生存时间短相关。这两个危险因素用于将患者按生存类型分为三组：有利（无危险因素）、中等（一个危险因素）和不利（两个危险因素）。有利组在1、6和12个月时的中位生存率分别为94.4%、57.3%和44.9%；中等组分别为78.0%、36.3%和15.5%；不利组分别为46.4%、14.3%和7.1%（P < 0.001）。
我们的分层模型可能有助于确定MUO患者是否适合进行UD。
