Impact of Hydroureteronephosis on Prognosis of Stage IIIB Cervical Cancer

Introduction: Cervical Cancer is the second most common cancer among women in India. Majority of the patients are diagnosed in an advanced stage. Stage IIIB Cervical cancer include those with pelvic side wall involvement or hydronephrosis. Presence of hydronephrosis negatively affects the prognosis. There are no guidelines for management of hydronephrosis in patients with cervical cancer also, there is no evidence that urinary diversion procedure improves survival.

Methodology: A retrospective analysis of all patients with Cervical cancer Stage IIIB (The International Federation of Gynecology and Obstetrics 2014 staging) between 1st January, 2015 to 31st January, 2015 presenting to the outpatient department of Dr. Bhubaneshwar Borooah Cancer Institute (BBCI), Guwahati was done. Eligible patients were divided into two groups, the study group was patients with hydronephrosis, and the control group patients were without hydronephrosis. Both the groups were compared based on demographic profile, cancer cell type, treatment duration, radiotherapy dose, chemotherapy, residual disease after 6weeks, 5-year overall survival.

Results: Total number of patients with Cervical Cancer Stage IIIB included in the study was 87, out of which 20 patients had Hydronephrosis (study group) and 67 patients without hydronephrosis (control group). The Mean age of patients in the study group was 53 years(44- 62) and in the control group was 51years(41-61). Among patients with hydronephrosis, 55% underwent urinary diversion procedures. The mean 5-year overall survival is 28.4 months (Median – 19.3months) in patients with hydronephrosis and 55.4 (Median-66.5 months) in patients without hydronephrosis (P= 0.001).

Discussion: The presence of hydronephrosis in patients with Cervical cancer is a predictor of poor outcome. Thus, special mention in staging should be considered about the presence of hydronephrosis. The management should be done by a multi-disciplinary team and patient counseling should be done thoroughly.