Hydronephrosis in patients with cervical cancer: an assessment of morbidity and survival

Abstract

Purpose 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). Conclusion 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.

Effect of Hydronephrosis on Survival in Advanced Stage Cervical Cancer

“…Obstructive uropathy is encountered in 14 to 44 percent of the cases with cervical cancer, and is a common cause of cervical cancer related mortality (Chao et al 1998;Rose et al, 2010;Wit and Horenbas, 2014;Patel et al, 2015). Besides medical treatment, percutaneous nephrostomy and ureteral stent placement is commonly undertaken.…”

Total Colpectomy Increases the Risk of Postoperative Hydronephrosis in Vaginal Cancer Patients

“…Symptoms are most often absent, as hydronephrosis has a progressive onset and the contralateral kidney may assure adequate function, leading to a delayed diagnosis. 9,10 In this study, hydronephrosis was seen in the postoperative period in both cervical and vaginal cancer patients, with a significantly higher incidence in the second group (43.8%).…”

“…7,8 Several studies have shown, in the case of patients undergoing modified radical hysterectomy with pelvic lymphadenectomy, especially for cervical cancer, that hydronephrosis is not an uncommon late complication, with significant impact not only on quality of life, but also on survival. 9,10 Scarce data are available in the literature regarding the incidence and impact on survival of postoperative hydronephrosis in vaginal cancer patients.…”

Impact of cancers on the kidney function and structure; an ignored entity

“…The most common sites of such metastasis are the lungs, bones, aorta, and celiac and supraclavicular lymph nodes, whereas, kidney metastasis is rare (34). A very common complication of advanced cervical cancer is obstructive nephropathy which one of the best techniques for resolving the obstruction could be ultrasonography-guided percutaneous neph rostomy (PCN) (35). In fact, PCN can recover renal function of more than 60% of cervical cancer patients, resulting in preventing renal replacement therapy in these patients (36).…”

“…In fact, PCN can recover renal function of more than 60% of cervical cancer patients, resulting in preventing renal replacement therapy in these patients (36). In addition, cervical cancer patients may develop hydronephrosis, as a cancer-related or cancer treatmentrelated complication, which is associated with higher morbidity and worse survival (35).…”