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Longitudinal Outcomes from Conservative Management of Cervical Cancer Associated Ureteral Obstruction
Hannah E Botkin1, Kathryn N Faidley1, Bradley T Loeffler2
1Department of Urology, University of Iowa, Carver College of Medicine, Iowa City, Iowa.
Insights
Hydronephrosis (HN) in cervical cancer (CCa) patients has a low resolution rate. Percutaneous nephrostomy (PCN) is associated with better treatment outcomes than ureteral stents (US) for HN in CCa.
Area of Science:
- Urology
- Oncology
- Nephrology
Background:
- Hydronephrosis (HN) is a common comorbidity in cervical cancer (CCa) patients.
- Improving CCa treatments necessitate better long-term HN management strategies.
Purpose of the Study:
- To identify predictors of hydronephrosis (HN) resolution.
- To identify predictors of HN treatment failure in cervical cancer (CCa) patients.
Main Methods:
- Retrospective review of 1670 CCa patients from 2004-2019.
- Analysis of patient, renal/HN, and cancer covariates.
- Logistic regression and competing risk Cox regression models were used to evaluate outcomes.
Main Results:
- 10.7% of CCa patients developed HN; 81% underwent initial PCN or US placement.
- Initial ureteral stent (US) placement had a 3.2-fold increased risk of treatment failure compared to percutaneous nephrostomy (PCN).
- HN resolution without reconstruction was predicted by concurrent diagnosis with CCa and bilateral HN.
Conclusions:
- Cervical cancer-associated hydronephrosis (CCa-HN) shows limited resolution (19% at 12 months).
- HN developing after CCa treatment is less likely to resolve without reconstruction.
- While PCN and US have similar complication rates, PCN demonstrates superior initial treatment success rates.
Objective:
To identify predictors of hydronephrosis (HN) resolution and HN treatment failure. HN is a common comorbid condition with cervical cancer (CCa). Treatments for CCa continue to improve and long-term management strategies of HN are becoming increasingly necessary.
Methods:
A query of a single hospital (2004 - 2019) ICD-9 and CPT codes was made to develop a cohort of CCa patients with HN. A retrospective review was performed. The effects of patient, renal/HN, and cancer covariates on time to HN treatment failure, treatment complications and time to HN resolution were evaluated using logistic regression and competing risk Cox regression models.
Results:
Of the 1670 women treated for CCa during the study period, 179 (10.7%) developed HN (n = 72 (40%) bilateral), 78 (44%) at time of CCa diagnosis and 101 (56%) as a result of treatment, of which 145 (81%) underwent initial treatment with a PCN (n = 77, 53%) or US (n = 68, 47%). Complication rates were similar between PCN (56%) and US (61%) when adjusting for treatment time. Initial treatment failure was more likely with US vs PCN (HR 3.2, P <0.01). HN resolution (n = 32, 22%) without reconstruction was predicted by HN concurrent with CCa diagnosis (HR 3.1, P <0.01) and bilateral HN (HR 0.2, P <0.01).
Conclusion:
CCa associated HN has a resolution rate of only 19% at 12 months. Those presenting with HN after CCa treatment are less likely to resolve without reconstruction. PCN and US have similar complication rates but initial US placement has a nearly three times increased risk of failing than PCN.
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