Nathan Arjun, Morris Melanie, Parry Matthew G, Berry Brendan, Sujenthiran Arunan, Nossiter Julie, Payne Heather, Van Der Meulen Jan, Clarke Noel W, Green James S A
Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
Division of Surgery and Interventional Sciences, University College London, London, UK.
BJU Int. 2022 Nov;130(5):688-695. doi: 10.1111/bju.15766. Epub 2022 May 12.
To develop and validate a coding framework to identify interventions for upper tract obstructive uropathy (UTOU) in men with locally advanced and metastatic prostate cancer (PCa) using administrative hospital data to assess clinical outcomes. There are no population-based studies on the incidence, treatment, and outcomes of this complication.
Patients newly diagnosed with PCa between April 2014 and March 2019 were identified in the English cancer registry. A coding framework based on procedure (Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures fourth edition) and diagnostic (International Classification of Diseases, 10th edition) codes was developed and validated. Subsequent clinical outcomes were determined using Hospital Episodes Statistics to determine the utility of the intervention.
A total of 77 010 patients newly diagnosed with locally advanced, and 30 083 patients with metastatic PCa were identified. Of these, 1951 (1.8%) patients underwent an intervention for UTOU according to our coding framework: 830 (42.5%) had locally advanced disease and 1121 (57.5%) had metastatic disease. In all, 844 (43.3%) had a percutaneous nephrostomy (PCN), 473 (24.2%) had a PCN with antegrade stent, and 634 (32.5%) had a retrograde stent. The mean follow-up was 43.2 months. The cumulative incidence of the use of these interventions at 1, 3, and 5 years was 2.5%, 3.6% and 4.2% in men with metastases compared to 0.5%, 0.9% and 1.4% in men with locally advanced disease.
A new coding framework, developed to identify procedures for UTOU was applied in the largest study to date of UTOU in men with primary locally advanced and metastatic PCa. Results demonstrated that 2% of men with locally advanced PCa and 4% of men with metastatic PCa require an intervention to resolve UTOU within 5 years of their PCa diagnosis.
开发并验证一种编码框架，用于利用医院管理数据识别局部晚期和转移性前列腺癌（PCa）男性患者上尿路梗阻性肾病（UTOU）的干预措施，以评估临床结局。目前尚无基于人群的关于该并发症的发病率、治疗及结局的研究。
在英国癌症登记处中识别出2014年4月至2019年3月期间新诊断为PCa的患者。开发并验证了一个基于手术操作（人口普查与调查办公室外科手术和操作分类第四版）和诊断（国际疾病分类第十版）编码的编码框架。随后利用医院病历统计数据确定干预措施的效用，以判定后续临床结局。
共识别出77010例新诊断为局部晚期的患者以及30083例转移性PCa患者。其中，根据我们的编码框架，1951例（1.8%）患者接受了UTOU干预：830例（42.5%）患有局部晚期疾病，1121例（57.5%）患有转移性疾病。总计844例（43.3%）接受了经皮肾造瘘术（PCN），473例（24.2%）接受了PCN并置入顺行支架，634例（32.5%）接受了逆行支架置入。平均随访时间为43.2个月。与局部晚期疾病男性患者1年、3年和5年时这些干预措施的累积使用率0.5%、0.9%和1.4%相比，转移性男性患者的累积使用率分别为2.5%、3.6%和4.2%。
一个用于识别UTOU手术操作的新编码框架应用于迄今为止关于原发性局部晚期和转移性PCa男性患者UTOU的最大规模研究中。结果表明，2%的局部晚期PCa男性患者和4%的转移性PCa男性患者在PCa诊断后的5年内需要进行干预以解决UTOU问题。
