Percutaneous nephrostomy in cervical cancer patients: a retrospective analysis

ABSTRACT

Objectives: To evaluate the outcome of patients with cervical carcinoma submitted to percutaneous nephrostomy due to malignant ureteral obstruction.

Material and Methods: Retrospective cohort study with data obtained from medical records of patients diagnosed with cervical carcinoma with renal dysfunction (AKIN = stage 2) undergoing PCN for malignant obstructive uropathy between January 2019 and December 2020 at a tertiary hospital in Recife, Brazil.

Results: We evaluated 31 patients submitted to percutaneous nephrostomy. Median age was 50 years, and the majority of women were non-white with an elementary education. Twenty-one patients required hemodialysis before the procedure, and 61.9% of them recovered renal function after nephrostomy. Bleeding and nephrostomy tube displacement were the leading causes of complications in the first 30 days (69%). Median overall survival after the procedure was 8.7 months. Survival was significantly worse in patients with anemia, ECOG performance status = 2 (p=0.04), pre-nephrostomy dialysis (p=0.01), and not recovery of renal function after PCN.

Conclusions: Performing urinary diversion through percutaneous nephrostomy seems to offer greater benefits in patients with better functionality. Given the morbidity and complications inherent to percutaneous nephrostomy, the profile of patients who benefit most from the procedure remains unclear. Referrals for the procedure must be individualized and consider the patient’s desire, treatment perspectives, and functionality.

RESUMO

Objetivos: Avaliar a evolução de pacientes com carcinoma cervical submetidos à nefrostomia percutânea por obstrução ureteral maligna.

Material e Métodos: Estudo de coorte retrospectivo com dados obtidos de prontuários de pacientes diagnosticados com carcinoma cervical com disfunção renal (AKIN = estágio 2) submetidos à nefrostomia percutânea por uropatia obstrutiva maligna entre janeiro de 2019 e dezembro de 2020, em um hospital terciário em Recife, Brasil.

Resultados: Avaliamos 31 pacientes submetidos à nefrostomia percutânea. A idade média foi de 50 anos, e a maioria das mulheres não eram brancas com ensino fundamental. Vinte e um pacientes necessitaram de hemodiálise antes do procedimento, e 61,9% deles recuperaram a função renal após a nefrostomia. Sangramento e deslocamento do tubo de nefrostomia foram as principais causas de complicações nos primeiros 30 dias (69%). A sobrevida global mediana após o procedimento foi de 8,7 meses. A sobrevida foi significativamente pior em pacientes com anemia, escala de desempenho ECOG = 2 (p=0,04), diálise pré-nefrostomia (p=0,01) e não recuperação da função renal após nefrostomia percutânea.

Conclusões: A realização da derivação urinária por nefrostomia percutânea parece oferecer maiores benefícios em pacientes com melhor funcionalidade. Dada a morbidade e as complicações inerentes à nefrostomia percutânea, o perfil dos pacientes que mais se beneficiam com o procedimento permanece incerto. O encaminhamento para o procedimento deve ser individualizado e levar em consideração o desejo do paciente, as perspectivas de tratamento e a funcionalidade.

Keywords:

Uterine cervical neoplasms - Hydronephrosis, Ureteral obstruction - Urinary diversion - Nephrostomy, Percutaneous

Descritores:

Neoplasias do colo do útero - Hidronefrose, Obstrução ureteral - Derivação urinária - Nefrostomia percutânea

Publication History

Received: 11 December 2022

Accepted: 18 May 2023

Article published online:
15 August 2023

• REFERENCES

• 1 World Health Organization (WHO). Global strategy to accelerate the elimination of cervical cancer as a public health problem [Internet]. Geneva: WHO; 2020. [access in 2021 Apr 17]. Available from https://www.who.int/publications/i/item/9789240014107
• 2 Ministério da Saúde (BR), Instituto Nacional do Câncer (INCA). Estimativa 2023: incidência de câncer no Brasil [Internet]. Brasília (DF): Ministério da Saúde/INCA; 2023. [access in 2021, June 27]. Available from https://www.inca.gov.br/publicacoes/livros/estimativa-2023-incidencia-de-cancer-no-brasil
• 3 Bhatla N, Berek JS, Fredes MC, Denny LA, Grenman S, Karunaratne K. et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynecol Obstetr 2019; [cited 2021 Apr 25] 145 (01) 129-35
• 4 Quinn MA, Benedet JL, Odicino F, Maisonneuve P, Beller U, Creasman WT. et al. Carcinoma of the cervix uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynecol Obstetr [Internet] 2006; [cited 2021 Apr 25] 95 Suppl 1 S43-S103 Available from https://pubmed.ncbi.nlm.nih.gov/17161167/
• 5 National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in Oncology: cervical cancer [Internet]. Pennsylvania: NCCN; 2020. [access in 2021 Apr 25]. Available from https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf
• 6 Lapitan MCM, Buckley BS. Impact of palliative urinary diversion by percutaneous nephrostomy drainage and ureteral stenting among patients with advanced cervical cancer and obstructive uropathy: a prospective cohort. J Obstetr Gynaecol Res 2011; [cited 2021 Apr 25] 37 (08) 1061-70
• 7 Rose PG, Ali S, Whitney CW, Lanciano R, Stehman FB. Impact of hydronephrosis on outcome of stage III-B cervical cancer patients with disease limited to the pelvis, treated with radiation and concurrent chemotherapy: a Gynecologic Oncology Group study. Gynecol Oncol 2010; [cited 2021 Apr 25] 117 (02) 270-5
• 8 Pergialiotis V, Bellos I, Thomakos N, Haidopoulos D, Perrea DN, Kontzoglou K. et al. Survival outcomes of patients with cervical cancer and accompanying hydronephrosis: a systematic review of the literature. Oncol Rev [Internet] 2019; [cited 2021 Apr 25] 13 (387) 23-29 Available from https://pubmed.ncbi.nlm.nih.gov/30746036/
• 9 Dienstmann R, Pinto CS, Pereira MT, Small IA, Ferreira CG. Palliative percutaneous nephrostomy in recurrent cervical cancer: a retrospective analysis of 50 consecutive cases. J Pain Sympt Manage 2008; [cited 2021 Apr 27] 36 (02) 185-90
• 10 Emmert C, Rassler J, Köhler U. Survival and quality of life after percutaneous nephrostomy for malignant ureteric obstruction in patients with terminal cervical cancer. Arch Gynecologic Obstetrics [Internet] 1997; [cited 2021 April 27] 259 (03) 147-51 Available from https://pubmed.ncbi.nlm.nih.gov/9187468/
• 11 Radecka E, Magnusson M, Magnusson A. Survival time and period of catheterization in patients treated with percutaneous nephrostomy for urinary obstruction due to malignancy. Acta Radiol 2006; [cited 2021 April 28] 47 (03) 328-31
• 12 Cohen PA, Jhingran A, Oaknin A, Denny L. Cervical cancer. Lancet 2019; Jan; [cited 2021 May 10] 393 10167 169-82
• 13 Maguire PJ, Sobota A, Mulholland D, Ryan JM, Gleeson N. Incidence, management, and sequelae of ureteric obstruction in women with cervical cancer. Support Care Cancer 2019; May; [cited 2023 Jan 14] 28 (02) 725-30
• 14 Atuhairwe S, Busingye RB, Sekikubo M, Nakimuli A, Mutyaba T. Urologic complications among women with advanced cervical cancer at a tertiary referral hospital in Uganda. Int J Gynecol Obstetr 2011; Dec; [cited 2021 Jan 14] 115 (03) 282-4 Available from https://pubmed.ncbi.nlm.nih.gov/21937039/
• 15 Souza AC, Souza AN, Kirsztajn R, Kirsztajn GM. Cervical cancer: renal complications and survival after percutaneous nephrostomy. Rev Assoc Med Bras (1992) 2016; May/Jun 62 (03) 255-61
• 16 Plesinac-Karapandzic V, Masulovic D, Markovic B, Djuric-Stefanovic A, Plesinac S, Vucicevic D. et al. Percutaneous nephrostomy in the management of advanced and terminal-stage gynecologic malignancies: outcome and complications. Eur J Gynaecol Oncol [Internet] 2010; [cited 2021, October 22] 31 (06) 645-50 Available from https://pubmed.ncbi.nlm.nih.gov/21319508/
• 17 Tan S, Tao Z, Bian X, Zhao Y, Wang N, Chen X. et al. Ureteral stent placement and percutaneous nephrostomy in the management of hydronephrosis secondary to cervical cancer. Eur J Obstetr Gynecol Reprod Biol 2019; [cited 2022 Jan 18] 241: 99-103
• 18 Noegroho BS, Kurniawan AP, Wijayanti Z, Mustafa A. Factors affecting survival outcome after percutaneous nephrostomy as palliative urinary diversion in obstructive uropathy due to advance cervical cancer patients. Asian Pac J Cancer Prev 2021; Apr 22 (04) 1211-6
• 19 Patel K, Foster NR, Kumar A, Grudem M, Longenbach S, Bakkum-Gamez J. et al. Hydronephrosis in patients with cervical cancer: an assessment of morbidity and survival. Support Care Cancer 2014; [cited 2022 Jan 18] 23 (05) 1303-9
• 20 Lee YY, Choi CH, Kim HJ, Kim TJ, Lee JW, Lee JH. et al. Pretreatment neutrophil: lymphocyte ratio as a prognostic factor in cervical carcinoma. Anticancer Res [Internet] 2012; [cited 2022 Jan 24] 32 (04) 1555-61 Available from https://ar.iiarjournals.org/content/32/4/1555
• 21 Ittiamornlert P, Ruengkhachorn I. Neutrophil-lymphocyte ratio as a predictor of oncologic outcomes in stage IV-B, persistent, or recurrent cervical cancer patients treated by chemotherapy. BMC Cancer [Internet] 2019; Jan; [cited 2022 Jan 24] 19 (51) 51 Available from https://bmccancer.biomedcentral.com/articles/10.1186/s12885-019-5269-1
• 22 Nakamura K, Nakayama K, Tatsumi N, Minamoto T, Ishibashi T, Ohnishi K. et al. Prognostic significance of pre-treatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in non-surgically treated uterine cervical carcinoma. Mol Clin Oncol [Internet] 2018; [cited 2022 Jan 24] 9 (02) 138-44 Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6083402/