Abstract: PD21-10
Sources of Funding: None.

Introduction

Controversies exist as to whether active stone removal should be performed in patients with poor performance status (PS) because of their short life expectancy and perioperative risks. The purpose of the present study was to clarify whether stone removal for patients with poor PS improves their prognosis.

Methods

We retrospectively reviewed the charts of 81 patients with poor PS (Eastern Cooperative Oncology Group PS 3 or 4) treated for upper urinary tract stones from January 2009 to March 2016. Seven patients who experienced spontaneous stone expulsion were excluded and 74 patients were enrolled in this study. Patients were classified into operation group and non-operation group based on the presence of active stone removal. We defined stone-specific survival (SSS), and compared overall survival (OS) and SSS between two groups by Kaplan-Meier method/log-rank test. In addition, univariate and multivariate analyses of OS and SSS were performed using Cox proportional hazards model.

Results

A total of 52 patients (70.3%) received active stone removal (operation group) by either ESWL (n=6), ureteroscopy (n=39), percutaneous nephrolithotomy (n=6) or nephrectomy (n=1). Overall stone free-rate was 78.8% and perioperative complication was observed in 9 patients (17.3%). While, 22 patients (29.7%) underwent conservative treatment (non-operation group). Operation and non-operation groups showed two-year OS rates of 88.0% and 38.4%, respectively (p<0.01), and two-year SSS rates of 100% and 61.3%, respectively (p<0.01) (Figure). On multivariate analysis, stone removal was not significant, but was considered possible favorable predictor for OS (HR 0.43, 95% CI 0.16 – 1.09) after adjustment for factors including age and Charlson comorbidity index. Moreover, stone removal was only independent predictor for SSS (HR 0.06, 95% CI 0.00 – 0.43) (Table).

Conclusions

Active stone removal could prevent stone-related deaths, possibly leading to prolonged overall survival in patients with poor PS.

Funding

None.