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Predicting Factors for Stent Failure-Free Survival in Patients With a Malignant Ureteral Obstruction Managed With Ureteral Stents

대한비뇨기과학회지 2013년 54권 5호 p.316 ~ 321
 ( Yu Seong-Hyeon ) - Chonnam National University Medical School Department of Urology

 ( Ryu Je-Guk ) - Chonnam National University Medical School Department of Urology
 ( Jeong Se-Heon ) - Chonnam National University Medical School Department of Urology
 ( Hwang Eu-Chang ) - Chonnam National University Medical School Department of Urology
 ( Jang Won-Seok ) - Chonnam National University Medical School Department of Urology
 ( Yu Ho-Song ) - Chonnam National University Medical School Department of Urology
 ( Kim Sun-Ouck ) - Chonnam National University Medical School Department of Urology
 ( Jung Seung-Il ) - Chonnam National University Medical School Department of Urology
 ( Kang Taek-Won ) - Chonnam National University Medical School Department of Urology
 ( Kwon Dong-Deuk ) - Chonnam National University Medical School Department of Urology
 ( Park Kwang-Sung ) - Chonnam National University Medical School Department of Urology
 ( Hwang Jun-Eul ) - Chonnam National University Medical School Department of Hematology-Oncology
 ( Kim Geun-Soo ) - Gwangju Hospital Department of Urology
 ( Hwang In-Sang ) - Chonnam National University Medical School Department of Urology

Abstract


Purpose: To determine predictive factors for stent failure-free survival in patients treated with a retrograde ureteral stent for a malignant ureteral obstruction.

Materials and Methods: We retrospectively reviewed 71 patients who underwent insertion of a cystoscopic ureteral stent due to a malignant ureteral obstruction between May 2004 and June 2011. Performance status, type of cancer, hydronephrosis grade, location of the obstruction, presence of bladder invasion, C-reactive protein (CRP), serum albumin, and inflammation-based prognostic score (Glasgow prognostic score, GPS) were assessed using a Cox proportional regression hazard model as predicting factors for stent failure.

Results: A univariate analysis indicted that hypoalbuminemia (<3.5 g/dL; hazard ratio [HR], 2.43; 95% confidence interval [CI], 1.21 to 4.86; p=0.012), elevated CRP (≥1 mg/dL; HR, 4.79; 95% CI, 2.0 to 11.1; p=0.001), and presence of a distal ureter obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.021) were associated with stent failure-free survival. A multivariate analysis revealed that the presence of a mid and lower ureteral obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.007), GPS ≥1 (HR, 7.22; 95% CI, 2.89 to 18.0; p=0.001), and elevated serum creatinine before ureteral stent placement (>1.2 mg/dL; HR, 2.16; 95% CI, 1.02 to 4.57; p=0.044) were associated with stent failure-free survival.

Conclusions: A mid or lower ureteral obstruction, GPS ≥1, and serum creatinine before ureteral stent insertion >1.2 mg/dL were unfavorable predictors of stent failure-free survival. These factors may help urologists predict survival time.

키워드

Neoplasm metastasis;Stents;Ureteral obstruction
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