title: Impact of hydronephrosis on outcome of stage IIIB cervical cancer patients with disease limited to the pelvis, treated with radiation and concurrent chemotherapy: a Gynecologic Oncology Group study.
abstract: OBJECTIVE
  To estimate the significance of hydronephrosis and impact of ureteral obstruction relief on outcome in patients with stage IIIB cervical cancer treated with radiation and concurrent chemotherapy.
  
  
  METHODS
  We retrospectively studied stage IIIB cervical cancer patients treated on GOG trials 56, 85, 120 and 165 evaluating radiation and concurrent chemotherapy. Eligible patient records were reviewed to assess the presence of hydronephrosis and treatment of ureteral obstruction. Patients were classified into three groups; no hydronephrosis, hydronephrosis relieved from ureteral obstruction via stent or percutaneous nephrostomy and hydronephrosis without treatment of ureteral obstruction.
  
  
  RESULTS
  539 stage IIIB patients were studied. Hydronephrosis was present in 238 (44.2%). Patient age, race, and tumor characteristics (size, histology and grade) were not significantly different between patients with or without hydronephrosis. Patients with hydronephrosis received similar doses of radiation and cisplatin-based chemotherapy. Both overall and progression-free survival were worse with hydronephrosis (log-rank test p value=0.0189 and 0.0186, respectively). Univariable analysis identified five prognostic factors; pelvic nodal metastasis (p=0.0001), tumor diameter (p=0.0007), cisplatin-based concurrent chemoradiation (p=0.0031), hydronephrosis (p=0.0189), and performance status (p=0.0359). Hydronephrosis was associated with worse performance status (p<0.001). On multivariable analysis hydronephrosis was not a significant prognostic factor. Ureteral obstruction relief occurred for 88% of patients and was associated with improved survival.
  
  
  CONCLUSIONS
  In patients with stage IIIB cervical cancer restricted to the pelvis, hydronephrosis at presentation is a significant but not independent prognostic factor associated with poor performance status and poorer survival. Relief of ureteral obstruction is correlated with improved outcome.
authors.affiliation: Cleveland Clinic Foundation and Case Western Reserve University, Cleveland, OH 44195, USA. rosep@ccf.org
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rose
authors.forename: Shamshad
authors.initials: S
authors.lastname: Ali
authors.forename: Charles W
authors.initials: CW
authors.lastname: Whitney
authors.forename: Rachelle
authors.initials: R
authors.lastname: Lanciano
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Stehman
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000503:physiopathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D015996:Survival Rate; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000503:physiopathology / Q000601:surgery; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*