title: A prognostic model for survival after palliative urinary diversion for malignant ureteric obstruction: a prospective study of 208 patients.
abstract: OBJECTIVE
  To identify factors associated with survival after palliative urinary diversion (UD) for patients with malignant ureteric obstruction (MUO) and create a risk-stratification model for treatment decisions.
  
  
  METHODS
  We prospectively collected clinical and laboratory data for patients who underwent palliative UD by ureteric stenting or percutaneous nephrostomy (PCN) between 1 January 2009 and 1 November 2011 in two tertiary care university hospitals, with a minimum 6-month follow-up. Inclusion criteria were age >18 years and MUO confirmed by computed tomography, ultrasonography or magnetic resonance imaging. Factors related to poor prognosis were identified by Cox univariable and multivariable regression analyses, and a risk stratification model was created by Kaplan-Meier survival estimates at 1, 6 and 12 months, and log-rank tests.
  
  
  RESULTS
  The median (range) survival was 144 (0-1084) days for the 208 patients included after UD (58 ureteric stenting, 150 PCN); 164 patients died, 44 (21.2%) during hospitalisation. Overall survival did not differ by UD type (P = 0.216). The number of events related to malignancy (≥4) and Eastern Cooperative Oncology Group (ECOG) index (≥2) were associated with short survival on multivariable analysis. These two risk factors were used to divide patients into three groups by survival type: favourable (no factors), intermediate (one factor) and unfavourable (two factors). The median survival at 1, 6, and 12 months was 94.4%, 57.3% and 44.9% in the favourable group; 78.0%, 36.3%, and 15.5% in the intermediate group; and 46.4%, 14.3%, and 7.1% in the unfavourable group (P < 0.001).
  
  
  CONCLUSIONS
  Our stratification model may be useful to determine whether UD is indicated for patients with MUO.
authors.affiliation: Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Maurício D
authors.initials: MD
authors.lastname: Cordeiro
authors.affiliation: Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Rafael F
authors.initials: RF
authors.lastname: Coelho
authors.affiliation: Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Daher C
authors.initials: DC
authors.lastname: Chade
authors.affiliation: Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Rodrigo R
authors.initials: RR
authors.lastname: Pessoa
authors.affiliation: Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Mateus S
authors.initials: MS
authors.lastname: Chaib
authors.affiliation: Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil.
authors.forename: José R
authors.initials: JR
authors.lastname: Colombo-Júnior
authors.affiliation: Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil.
authors.forename: José
authors.initials: J
authors.lastname: Pontes-Júnior
authors.affiliation: Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Giuliano B
authors.initials: GB
authors.lastname: Guglielmetti
authors.affiliation: Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000368:Aged; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology; D014517:Ureteral Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods* / Q000401:mortality
keywords: hydronephrosis; palliative surgery; percutaneous nephrostomy; stent; survival; ureteric obstruction