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MINERVA UROLOGICA E NEFROLOGICA

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Minerva Urologica e Nefrologica 2016 October;68(5):437-43

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Development of prognostic model for predicting survival after retrograde placement of ureteral stent in advanced gastrointestinal cancer patients and its evaluation by decision curve analysis

Shingo KAWANO 1, Yoshinobu KOMAI 2, Junichiro ISHIOKA 4, Yasuyuki SAKAI 2, Nozomu FUSE 3, Masaaki ITO 1, Kazunori KIHARA 4, Norio SAITO 1

1 Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan; 2 Department of Urology, National Cancer Center Hospital East, Chiba, Japan; 3 Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan; 4 Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan


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BACKGROUND: The aim of this study was to determine risk factors for survival after retrograde placement of ureteral stents and develop a prognostic model for advanced gastrointestinal tract (GIT: esophagus, stomach, colon and rectum) cancer patients.
METHODS: We examined the clinical records of 122 patients who underwent retrograde placement of a ureteral stent against malignant extrinsic ureteral obstruction. A prediction model for survival after stenting was developed. We compared its clinical usefulness with our previous model based on the results from nephrostomy cases by decision curve analysis.
RESULTS: Median follow-up period was 201 days (8-1490) and 97 deaths occurred. The 1-year survival rate in this cohort was 29%. Based on multivariate analysis, primary site of colon origin, absence of retroperitoneal lymph node metastasis and serum albumin >3g/dL were significantly associated with a prolonged survival time. To develop a prognostic model, we divided the patients into 3 risk groups of favorable: 0-1 factors (N.=53), intermediate: 2 risk factors (N.=54), and poor: 3 risk factors (N.=15). There were significant differences in the survival profiles of these 3 risk groups (P<0.0001). Decision curve analyses revealed that the current model has a superior net benefit than our previous model for most of the examined probabilities.
CONCLUSIONS: We have developed a novel prognostic model for GIT cancer patients who were treated with retrograde placement of a ureteral stent. The current model should help urologists and medical oncologists to predict survival in cases of malignant extrinsic ureteral obstruction.

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yokomai@east.ncc.go.jp