Prognostic Model for Predicting Survival After Palliative Urinary Diversion for Ureteral Obstruction: Analysis of 140 Cases

PURPOSE: We identified patients with ureteral obstruction likely to benefit from palliative urinary diversion so that they can be advised appropriately. MATERIALS AND METHODS: A total of 140 patients with obstructive nephropathy secondary to advanced incurable malignant disease underwent percutaneous nephrostomy urinary diversion. Several variables were investigated including sex, age, type of primary malignancy, events related to malignant dissemination (metastasis, ascites and pleural effusion), number of events related to malignant dissemination, degree of hydronephrosis, location of obstruction, interval from initial diagnosis of bilateral hydronephrosis to percutaneous nephrostomy, and serum creatinine, hemoglobin and serum albumin levels before nephrostomy. RESULTS: Median overall survival was 96 days (range 2 to 1,283). The 1, 6 and 12-month survival rates were 78%, 30% and 12%, respectively. On multivariate analysis the number of events related to malignant dissemination (3 or more), degree of hydronephrosis (grade 1 or 2) and serum albumin before nephrostomy (3 gm/dl or less) were significantly associated with a short survival time. The patients were divided into 3 risk groups of favorable-0 risk factors (34 patients), intermediate-1 risk factor (60) and poor-2 or 3 risk factors (41). There were significant differences in the survival profiles of the 3 risk groups (p <0.0001). The 6-month survival rates for the favorable, intermediate and poor risk groups were 69%, 24% and 2%, respectively. CONCLUSIONS: The current stratification model may represent a useful tool for clinicians treating patients with ureteral obstruction due to advanced cancer.