Emergency room imaging in patients with genitourinary cancers: Analysis of the spectrum of CT findings and their relation to patient outcomes Journal Article
| Authors: | Woo, S.; Bou Ayache, J.; Sawan, P.; Infantino, J.; Gangai, N.; Wibmer, A.; Hricak, H.; Groeger, J. S.; Vargas, H. A. |
| Article Title: | Emergency room imaging in patients with genitourinary cancers: Analysis of the spectrum of CT findings and their relation to patient outcomes |
| Abstract: | Purpose: To assess the spectrum of computed tomography (CT) findings in patients with genitourinary cancers visiting the emergency room (ER) and evaluate the relationship between CT findings and overall survival (OS). Methods: Retrospective analysis of consecutive patients with genitourinary cancers undergoing CT during an ER visit at a tertiary cancer center during a 20-month period. CTs were considered positive if there were findings relevant to the presenting complaint(s). Demographic/clinical variables were recorded. OS was evaluated using Kaplan-Meier curves. Univariate and multivariate Cox proportional hazards regression (HR) was used to evaluate OS predictors. Results: Two hundred twenty-seven patients (243 visits) were included. The most common primary tumors were prostate (121 [49.8%]), bladder/urothelial (78 [32.1%]), and renal (69 [28.4%]). Common presenting complaints were abdominal pain (67 [27.6%]), respiratory symptoms (49 [20.2%]), neurological signs (37 [15.2%]), and fever (34 [14.0%]). CT findings were positive in 172 patients (70.8%) and included new/increased metastases (21.4% [52/243]), fluid collections (7.4% [18/243]), urinary tract infection/inflammation (6.2% [15/243]), enteritis/colitis (5.3% [13/243]), and pneumonia (4.9% [12/243]). A positive ER CT was associated with patient admission (p = 0.01). At multivariate analysis, independently predictive factors of shorter survival were positive ER CT (HR = 2.09 [95% CI 1.16–3.76, p = 0.01), hospital admission (HR = 2.17 [95% CI 1.38–3.41], p < 0.01), and recent systemic treatment (HR = 2.10 [95% CI 1.32–3.35], p < 0.01). Conclusion: When CT was performed, it was able to identify a structural cause for the presenting complaint in the majority of patients with genitourinary cancers attending the ER. A positive ER CT was associated with hospital admission and poorer overall survival. © 2020, American Society of Emergency Radiology. |
| Keywords: | survival; adult; cancer survival; controlled study; aged; fracture; primary tumor; major clinical study; overall survival; clinical feature; systemic therapy; follow up; cancer diagnosis; deep vein thrombosis; retrospective study; bladder cancer; urogenital tract cancer; renal cell carcinoma; abdominal pain; fever; pneumonia; prostate cancer; lung embolism; urinary tract infection; colitis; enteritis; iohexol; hospital admission; intestine obstruction; neurologic disease; transitional cell carcinoma; multiple cancer; emergency health service; computed tomography; brain infarction; multidetector computed tomography; hydronephrosis; lung hemorrhage; urolithiasis; genitourinary cancer; urogenital tract radiography; admission; human; male; female; priority journal; article; urinary tract inflammation; emergency room; dual energy computed tomography |
| Journal Title: | Emergency Radiology |
| Volume: | 27 |
| Issue: | 4 |
| ISSN: | 1070-3004 |
| Publisher: | Springer |
| Date Published: | 2020-08-01 |
| Start Page: | 413 |
| End Page: | 421 |
| Language: | English |
| DOI: | 10.1007/s10140-020-01774-5 |
| PUBMED: | 32249352 |
| PROVIDER: | scopus |
| PMCID: | PMC8278847 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 August 2020 -- Source: Scopus |
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