Monday, September 22, 2008

Prognosis after neph tubes

The Journal of Urology has a paper giving some general prognostic data in patients with advanced cancer and ureteral obstruction who require percutaneous nephrostomy tube placement.  The paper is a single institution (Japanese) case series of 140 patients who required neph tube placement due to obstructive uropathy from "advanced incurable malignant cancer."  The mean age was 57 years, with an equal mix of colon, gastric, and gynecologic cancers represented (75% of patients had one of these).  


Median survival was 96 days with 1, 6, and 12 month survivals 78%, 30%, and 12% respectively.  They also created a multivariate model to create a sort of mortality risk index:  low albumin, low-grade hydronephrosis, and having lots of metastases all predicted worse outcomes.  Why low-grade hydronephrosis was independently associated with worse outcomes (as opposed to high-grade) I don't know and the authors don't speculate.

I'm assuming there is some body of literature out there on prognosis and outcomes with neph tube insertion, although this is the first I've seen of it, and it's certainly important data to know.  It's always tough to know how to generalize data from other countries, but looking at the demographic/patient information data in this paper, these are very familiar patients to me, and, at least as far as survival in advanced cancer goes, there's very little any of us can do anywhere that has a major impact on longevity and I plan on treating these findings as generally applicable to my patients.

Christian, as our in-house prognostication guy, I'll let you contradict me here but I think most of us conceptualize prognosis is advanced cancer in two ways: one is looking at performance status/ECOG score/etc. and the other is looking for the presence or absence of 'sentinel' indicators of poor prognosis (e.g. hypercalemia, presence of a malignant pleural effusion, etc.). I'm adding obstructive nephropathy/neph tube placement to the list as well.  


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