The role of percutaneous nephrostomy in advanced cervical cancer: prognostic insights

Introduction: Cervical cancer is the fourth most common neoplasm in the world and a significant cause of mortality in women. Ureteral obstruction resulting in hydronephrosis due to tumor is a common presentation in advanced disease. Percutaneous nephrostomy can be performed in these cases for symptom relief and to enable subsequent treatments. However, the patient profile that would most benefit from the procedure is still debated in the literature.

Objective: This study aims to identify prognostic factors to better understand the role of this procedure in patients with cervical cancer.

Method: A cohort study was conducted with women diagnosed with cervical cancer who underwent percutaneous nephrostomy between January 2020 and June 2022 at a Brazilian oncology referral center. Sociodemographic and clinicopathological data were collected, and patients were followed up. Descriptive analysis of the data and Kaplan-Meier survival analysis were performed. Cox regression was used to analyze how and which study variables impacted survival. Complications such as obstruction or catheter displacement and infections were assessed.

Results: Forty women were recruited. Data were analyzed, and the overall survival was 28.21 weeks. We identified the following factors as improving prognosis in patients undergoing percutaneous nephrostomy: subsequent chemotherapy and/or radiotherapy. Improvement in renal function occurred in nearly 70% of cases; however, neither improvement nor recovery of renal function was significantly associated with survival. A total of 87.5% of the patients used the nephrostomy until the date of death or the end of the study, and 72.5% of them had at least one of the complications assessed, with an incidence of infection of 60%.

Conclusion: The most important prognostic value of nephrostomy appears to be the potential for subsequent oncological treatment. The benefit and indication of the procedure should be questioned when there is no prospect of subsequent oncological therapy, considering limited survival, a high rate of complications, and a lack of evidence in the literature for an improvement in the quality of life.

Corresponding author: Carla Rameri de Azevedo (e-mail: carla.rameri.de.azevedo@gmail.com).