Prognostic Marker for Patients With Malignant Ureter Obstruction

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Abstract

Palliative urinary diversion using percutaneous nephrostomy (PCN) tubes is a well established method to improve renal function. Several studies have shown some independent prognostic factors. In this study, we validated that low serum albumin and Na levels and the number of events related to malignant dissemination before PCN could be independent factors related to a poor prognosis. Using multivariate analysis we identified that a high serum C-reactive protein level was also associated with poor prognosis.

Purpose:

To investigate the relationship between overall survival (OS) and prognostic risk factors for patients with malignant ureteral obstruction.

Patients and Methods:

We retrospectively evaluated 214 patients who had received a nephrostomy for ureteral obstruction because of malignancy. Univariate and multivariate Cox regression models addressed OS.

Results:

The median OS was 6.4 months. The OS at 1, 3, 6, and 12 months were 89.5%, 72.4%, 53.0%, and 26.5%, respectively. Using univariate Cox regression analysis, serum levels of creatinine (P = .0131), albumin (P < .0001), sodium (P < .0001), potassium (P = .0141), corrected calcium (P = .0167), C-reactive protein (P < .0001), white blood cell count (P = .0246), and the number of events related to malignant dissemination (P < .0001) were associated with OS. Using multivariate Cox regression analysis, serum levels of albumin (P = .0147), sodium (P = .0046), C-reactive protein (P < .0001), and the number of events related to malignant dissemination (P = .0002) were independent predictors of OS.

Conclusion:

Low serum levels of albumin and sodium and the number of events related to malignant dissemination before PCN were independent factors associated with a poor prognosis. High serum C-reactive protein level was also associated with a poor prognosis using multivariate analysis.

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