Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2023 Nov;64(11):665-669. doi: 10.3349/ymj.2023.0117.
To analyze prognostic factors associated with ureteral stent failure and to develop a prediction model for malignant ureteral obstruction (MUO) in patients with non-urological cancers.
We retrospectively reviewed patients with non-urological cancers who underwent ureteral stenting or percutaneous nephrostomy (PCN) for MUO between 2006 and 2014. Variables predicting stent failure were identified using Cox regression analysis.
Of the 743 patients, 468 (63.0%) underwent ureteral stenting only, and 275 (37.0%) underwent PCN owing to technical (n=215) or functional (n=60) stent failure. The median overall survival was 4 [interquartile range (IQR) 1-11] months, and the median interval duration to stent failure was 2 (IQR 0-7) months. In univariate analysis, lower gastrointestinal cancer, previous radiotherapy to the pelvis, bladder invasion, lower ureteral obstruction, and low previous estimated glomerular filtration rate (eGFR) (<30 mL/min/1.73 m²) were significantly associated with a decreased survival rate. In multivariate analysis, bladder invasion and previous eGFR were significant predictors. With these two predictors, we divided patients into three groups based on their presence: low-risk (neither factor; n=516), intermediate-risk (one factor; n=206), and high-risk (both factors; n=21). The median stent failure-free survival rates of patients in the low-, intermediate-, and high-risk groups were 26 (8-unreached), 1 (0-18), and 0 (0-0) months, respectively (<0.001).
In cases of ureteral obstruction caused by non-urological cancers, patients with bladder invasion and a low eGFR showed poor stent failure-free survival. Therefore, PCN should be considered the primary procedure for these patients.
分析与输尿管支架失败相关的预后因素，并为非泌尿系统癌症患者的恶性输尿管梗阻（MUO）建立预测模型。
我们回顾性分析了 2006 年至 2014 年间因 MUO 接受输尿管支架置入或经皮肾造瘘术（PCN）的非泌尿系统癌症患者。使用 Cox 回归分析确定预测支架失败的变量。
743 例患者中，468 例（63.0%）仅行输尿管支架置入，275 例（37.0%）因技术原因（n=215）或功能原因（n=60）支架失败而行 PCN。总的中位生存时间为 4 [四分位间距（IQR）1-11] 个月，支架失败的中位间隔时间为 2 [IQR 0-7] 个月。单因素分析显示，下消化道癌症、盆腔放疗史、膀胱侵犯、下输尿管梗阻和较低的估算肾小球滤过率（eGFR）（<30 mL/min/1.73 m²）与生存率降低显著相关。多因素分析显示，膀胱侵犯和 eGFR 是独立的预测因素。根据这两个预测因素，我们将患者分为三组：低危组（均无上述因素；n=516）、中危组（有一个因素；n=206）和高危组（均有两个因素；n=21）。低、中、高危组患者的中位支架无失败生存率分别为 26（8 例未达到）、1（0-18）和 0（0-0）个月，差异具有统计学意义（<0.001）。
对于非泌尿系统癌症引起的输尿管梗阻患者，存在膀胱侵犯和 eGFR 较低的患者支架无失败生存率较差。因此，对于这些患者，应考虑首选 PCN 作为初始治疗。
