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.

Abstract

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.

• Authors: Shingo Kawano, Yoshinobu Komai, Junichiro Ishioka, Yasuyuki Sakai, Nozomu Fuse, Masaaki Ito, Kazunori Kihara, Norio Saito
• Journal: Minerva urologica e nefrologica = The Italian journal of urology and nephrology (Minerva Urol Nefrol) Vol. 68 Issue 5 Pg. 437-43 (Oct 2016) ISSN: 1827-1758 [Electronic] Italy
• PMID: 26554732 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Clinical Decision-Making
• Female
• Gastrointestinal Neoplasms (complications, mortality, surgery)
• Humans
• Male
• Middle Aged
• Models, Theoretical
• Prognosis
• Retrospective Studies
• Risk Factors
• Stents
• Survival Rate
• Ureter (surgery)
• Ureteral Obstruction (etiology, mortality, surgery)
• Urologic Surgical Procedures (methods)