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Clinical Outcomes After Urinary Diversion for Malignant Ureteral Obstruction Secondary to Non-urologic Cancer: An Analysis of 778 Cases

Authors
 Ji Eun Heo  ;  Dae Young Jeon  ;  Jongsoo Lee  ;  Won Sik Ham  ;  Young Deuk Choi  ;  Won Sik Jang 
Citation
 ANNALS OF SURGICAL ONCOLOGY, Vol.28(4) : 2367-2373, 2021-04 
Journal Title
ANNALS OF SURGICAL ONCOLOGY
ISSN
 1068-9265 
Issue Date
2021-04
MeSH
Humans ; Male ; Neoplasms* / complications ; Nephrostomy, Percutaneous* / adverse effects ; Retrospective Studies ; Stents ; Ureter* ; Ureteral Obstruction* / etiology ; Ureteral Obstruction* / surgery ; Urinary Diversion* / adverse effects
Abstract
Background: This study investigated patient outcomes after urinary diversion in order to manage malignant ureteral obstruction caused by non-urologic cancers and to evaluate predictive factors for overall survival.

Methods: The study retrospectively reviewed patients with non-urologic malignancies who underwent ureteral stenting or percutaneous nephrostomy for ureteral obstruction between 2006 and 2014. The variables for predicting overall survival were identified by Cox regression analysis.

Results: The study enrolled 778 patients, including 522 patients who underwent ureteral stenting and 256 patients who underwent percutaneous nephrostomy. Renal function was assessed immediately and then 2 weeks after urinary diversion. The median survival period was 5 months (interquartile range [IQR] 2-12 months). A total of 708 patients died. The patients who received chemotherapy after urinary diversion had a survival gain of 7 months compared with the patients who did not receive subsequent chemotherapy (p < 0.001). The survival rate did not differ between the various types of urinary diversion (p = 0.451). In the multivariate analysis, lower survival rates were significantly associated with male sex; previous chemotherapy without radiotherapy; an increasing number of events related to malignant dissemination; low preoperative hemoglobin (< 10 mg/dL), albumin (< 3 g/dL), and estimated glomerular filtration (< 60 mL/min/1.73 m2) rates; and no subsequent chemotherapy or radiotherapy.

Conclusions: In cases of ureteral obstruction caused by non-urologic malignancies, the overall survival was poor. However, the patients who received chemotherapy after urinary diversion had a survival gain of 7 months. Therefore, urinary diversion could be considered to preserve renal function for subsequent chemotherapy, whereas patients with the poor prognostic factors should be presented with the option of no intervention.
Full Text
https://link.springer.com/article/10.1245%2Fs10434-020-09423-4
DOI
10.1245/s10434-020-09423-4
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Lee, Jong Soo(이종수) ORCID logo https://orcid.org/0000-0002-9984-1138
Jang, Won Sik(장원식) ORCID logo https://orcid.org/0000-0002-9082-0381
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
Heo, Ji Eun(허지은) ORCID logo https://orcid.org/0000-0002-4184-8468
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/184289
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