Survival following palliative percutaneous nephrostomy tube insertion in patients with malignant ureteric obstruction: Validating a prognostic model

Abstract

Background and Aims Malignant ureteric obstruction (MUO) is a life-threatening complication of advanced cancer associated with short survival. Percutaneous nephrostomy (PCN) is a commonly employed technique to decompress MUO. Prognostic models have been developed to identify patients with poor outcomes. This study aimed to validate and update the recent model by Alawneh et al. [Alawneh A, Tuqan W, Innabi A, et al. Clinical Factors Associated With a Short Survival Time After Percutaneous Nephrostomy for Ureteric Obstruction in Cancer Patients: An Updated Model. J Pain Symptom Manag 2016;51(2):255–261]. Methods A retrospective analysis was performed on patients who received PCN for MUO over a 10-year period. Clinical and demographic details were recorded. Patients were stratified into prognostic groups and survival was described using the Kaplan-Meier method. Association between prognostic group, individual variables and mortality was investigated. Results 29 patients had received PCN for MUO. When stratified by Alawneh prognostic group, survival was 0.9 months (0 risk factors), 8.4 months (1 factor), 3.4 months (2 factors) and 4.1 months (3 factors). No statistical association was identified between prognostic group and mortality risk (Hazard Ratio [HR] 0.92; p = 0.72). The only variable associated with increased mortality was pre-nephrostomy haemoglobin <100 g/L (HR 2.6; p = 0.037). Conclusion Survival with MUO remains short, despite advances in supportive care and PCN. This study was unable to either validate or update the prognostic model, due to limited numbers. Further research with prospective studies is recommended.