title: Hydronephrosis in patients with cervical cancer: an assessment of morbidity and survival.
abstract: OBJECTIVE
  Hydronephrosis is a frequently observed but understudied complication in patients with cervical cancer. To better characterize hydronephrosis in cervical cancer patients, the current study sought (1) to describe hydronephrosis-associated morbidity and (2) to analyze the prognostic effect of hydronephrosis in patients with a broad range of cancer stages over time.
  
  
  METHODS
  The Mayo Clinic Tumor Registry was interrogated for all invasive cervical cancer patients seen at the Mayo Clinic from 2008 through 2013 in Rochester, Minnesota; these patients' medical records were then reviewed in detail.
  
  
  RESULTS
  Two hundred seventy-nine cervical cancer patients with a median age of 49 years and a range of cancer stages were included. Sixty-five patients (23 %) were diagnosed with hydronephrosis at some point during their disease course. In univariate analyses, hydronephrosis was associated with advanced cancer stage (p < 0.0001), squamous histology (p = 0.0079), and nonsurgical cancer treatment (p = 0.0039). In multivariate analyses, stage and tumor histology were associated with hydronephrosis. All but one patient underwent stent placement or urinary diversion; hydronephrosis-related morbidity included pain, urinary tract infections, nausea and vomiting, renal failure, and urinary tract bleeding. In landmark univariate survival analyses, hydronephrosis was associated with worse survival at all time points. In landmark multivariate analyses (adjusted for patient age, stage, cancer treatment, and tumor histology), hydronephrosis was associated with a trend toward worse survival over time (hazard ratios ranged from 1.47 to 4.69).
  
  
  CONCLUSIONS
  Hydronephrosis in cervical cancer patients is associated with notable morbidity. It is also associated with trends toward worse survival-even if it occurs after the original cancer diagnosis.
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Krishna
authors.initials: K
authors.lastname: Patel
authors.forename: Nathan R
authors.initials: NR
authors.lastname: Foster
authors.forename: Amanika
authors.initials: A
authors.lastname: Kumar
authors.forename: Megan
authors.initials: M
authors.lastname: Grudem
authors.forename: Sherri
authors.initials: S
authors.lastname: Longenbach
authors.forename: Jamie
authors.initials: J
authors.lastname: Bakkum-Gamez
authors.forename: Michael
authors.initials: M
authors.lastname: Haddock
authors.forename: Sean
authors.initials: S
authors.lastname: Dowdy
authors.forename: Aminah
authors.initials: A
authors.lastname: Jatoi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology* / Q000401:mortality* / Q000601:surgery; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D014547:Urinary Diversion; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000401:mortality* / Q000473:pathology; D055815:Young Adult