Shayo Gemini L, Abdallah Latifa Rajab, Lugina Emanuel L
Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
Ocean Road Cancer Institute (ORCI), Dar es Salaam, Tanzania.
Ecancermedicalscience. 2025 Jul 1;19:1940. doi: 10.3332/ecancer.2025.1940. eCollection 2025.
Locally advanced cervical cancer (LACC) can result in obstructive uropathy (OU). Urinary diversion (UD) is the treatment of LACC patients with OU. This study assessed the benefits of UD before or during radiotherapy by examining its effect on improving kidney function and survival in patients with LACC.
The study retrospectively analysed the clinical data of 119 women with LACC treated from January 2020 to December 2021. The treatment intention (radical or palliative) was decided by a multidisciplinary team based on the disease stage, Karnofsky performance status and degree of renal derangement. Treatment and outcome details were retrieved from electronic records. This included obtaining serum creatinine levels before the UD, 7 days after, 21 days after and 1 month after the UD. Time to normalisation of serum creatinine, feasibility of delivering planned treatment and overall survival were determined. The impact of various prognostic factors on outcomes was determined using univariate or multivariate analysis. The significance level was set at 0.05.
The mean age was 51.1 ± 9.9 years. Approximately a third of patients underwent UD. Percutaneous nephrostomy was the most frequently performed type of UD (92%). About 85% of patients had hydronephrosis, and 56.3% had unilateral hydronephrosis. The mean baseline serum creatinine level was 662 µmol/L for the entire cohort. There was a 53% reduction of serum creatinine from the baseline to 30 days post-UD ( = 0.001). The median equivalent dose in 2-Gy (EQD2) for the whole cohort was 86 Gy. The median survival time for the entire cohort was 20 months. In the multivariate analysis, UD resulted in a 40% decreased mortality risk (aHR 0.6, -value = 0.03). Patients who did not receive brachytherapy had 5.9 times more risk of mortality compared to those who had brachytherapy (aHR 5.9, -value = 0.001). EQD2 ≥72 Gy was associated with 40% less mortality risk than those who had EQD2 of <72 Gy (aHR 0.4, -value = 0.005). Patients with a maximum tumour diameter of more than 5 cm had 2 times higher mortality risk than those with a tumour with a maximum tumour diameter of less than 5 cm (aHR 2, -value = 0.005). Patients who were treated with concurrent chemoradiotherapy had 60% less risk of mortality compared to those treated with radiotherapy alone (aHR 0.4, -value = 0.048).
UD was associated with a 53% reduction in baseline serum creatinine levels 30 days post-UD, reducing mortality risk by 40%.
局部晚期宫颈癌（LACC）可导致梗阻性尿路病（OU）。尿流改道（UD）是治疗伴有OU的LACC患者的方法。本研究通过检查UD对改善LACC患者肾功能和生存的影响，评估在放疗前或放疗期间进行UD的益处。
本研究回顾性分析了2020年1月至2021年12月期间接受治疗的119例LACC女性患者的临床资料。治疗意向（根治性或姑息性）由多学科团队根据疾病分期、卡氏功能状态和肾脏紊乱程度决定。治疗和结局细节从电子记录中获取。这包括在UD前、UD后7天、21天和1个月时获取血清肌酐水平。确定血清肌酐恢复正常的时间、实施计划治疗的可行性和总生存期。使用单因素或多因素分析确定各种预后因素对结局的影响。显著性水平设定为0.05。
平均年龄为51.1±9.9岁。约三分之一的患者接受了UD。经皮肾造瘘术是最常实施的UD类型（92%）。约85%的患者有肾积水，56.3%的患者有单侧肾积水。整个队列的平均基线血清肌酐水平为662µmol/L。从基线到UD后30天，血清肌酐降低了53%（P = 0.001）。整个队列的2-Gy等效剂量中位数（EQD2）为86 Gy。整个队列的中位生存时间为20个月。在多因素分析中，UD使死亡风险降低了40%（风险比0.6，P值 = 0.03）。未接受近距离放疗的患者死亡风险是接受近距离放疗患者的5.9倍（风险比5.9，P值 = 0.001）。EQD2≥72 Gy的患者死亡风险比EQD2<72 Gy的患者低40%（风险比0.4，P值 = 0.005）。最大肿瘤直径超过5 cm的患者死亡风险是最大肿瘤直径小于5 cm患者的2倍（风险比2，P值 = 0.005）。接受同步放化疗的患者死亡风险比仅接受放疗的患者低60%（风险比0.4，P值 = 0.048）。
UD与UD后30天基线血清肌酐水平降低53%相关，使死亡风险降低40%。
