A prognostic model for survival after palliative urinary diversion for malignant ureteric obstruction: a prospective study of 208 patients
A prognostic model for survival after palliative urinary diversion for malignant ureteric obstruction: a prospective study of 208 patients
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DOI：
10.1111/bju.12963
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发表时间：
2016-02-01
影响因子：
4.5
通讯作者：
Srougi, Miguel
中科院分区：
文献类型：
--
作者：
Cordeiro, Maurcio D.;Coelho, Rafael F.;Srougi, Miguel
目的确定恶性输尿管梗阻（MUO）患者姑息性尿流改道（UD）后生存的相关因素，并为治疗决策建立风险分层模型Patients and MethodsWe前瞻性收集接受姑息性UD输尿管支架置入术或经皮肾造口术（PCN）患者的临床和实验室数据2009年1月1日至2011年11月1日期间，在两所三级保健大学医院进行了至少6个月的随访。入选标准为年龄> 18岁，且经计算机断层扫描、超声或磁共振成像证实为MUO。通过考克斯单变量和多变量回归分析确定与不良预后相关的因素，并通过Kaplan-Meier生存估计在1，6和12个月和对数秩检验建立风险分层模型。（58例输尿管支架植入术，150例PCN）; 164例患者死亡，44例（21.2%）在住院期间死亡。不同UD类型的总生存率无差异（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）与生存期短相关。这两个风险因素被用于将患者按生存类型分为三组：有利（无因素）、中等（一个因素）和不利（两个因素）。良好组1、6、12个月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%;分别为46.4%，14.3%，结论本分层模型可用于判断MUO患者是否适用UD。
ObjectiveTo 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.Patients and MethodsWe 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.ResultsThe 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).ConclusionsOur stratification model may be useful to determine whether UD is indicated for patients with MUO.