Survival and prognostic factors for patients with malignant central airway obstruction following airway metallic stent placement

Abstract

Background: There have been many studies on the effectiveness and complications of airway stent, but few had focused on factors that affect survival after stent placement. This study intended to assess the factors associated with the survival in patients with malignant central airway obstruction (MCAO) after airway metallic stent placement. Methods: The clinical data of adult MCAO patients who underwent stent placement form February 2003 to June 2017 in the First Affiliated Hospital of Soochow University in China were retrospectively analyzed.The survival rates were compared using Log-rank tests. Potential prognostic factors were identified using multivariate Cox hazard regression models. Results: Total 102 MCAO patients were included in this study. The median survival time of these patients after airway metallic stent placement was 4.1 months. Multivariate analysis showed that MCAO patients receiving radiotherapy [hazard ratio (HR) 0.554; 95% confidence interval (CI): 0.308-0.999] or chemoradiotherapy (HR 0.251; 95% CI: 0.126-0.499) after stenting had better prognosis. However, ECOG PS ≥3 score prior to the stenting (HR 2.193; 95% CI: 1.364-3.526) and stents placed in both trachea and main bronchus (HR 2.458; 95% CI: 1.384-4.366) were associated with worse survival.Conclusions: In our results, survival of MCAO patients after airway metallic stenting was related to ECOG PS score prior to the stenting, the site of stent placement and we have hereby proposed for the first time that having opportunity to receive radiotherapy or chemoradiotherapy after stenting contribute to better prognosis.

Ablative Procedures and Additional Anticancer Therapy Prolong the Survival in Patients With Endoluminal or Mixed-type Malignant Central Airway Obstruction: A Single-institution Retrospective Study

“…In our study, the median OS time was 18.5 months in the TM group, 3.8 months in the MX group and 4.5 months in the EX group, consistent with previous reports [8] [9] [14] [16]. In addition, in the TM group, 30% of the patients had respiratory failure (severe airway obstruction), and 89% of the patients needed post-TBI anticancer therapy.…”

Self-Expandable Metal Stent in the Management of Malignant Airway Disorders

“…The proportion of Y-shaped SEMS (54.2% vs. 30.5%) in the malignant TEF group was higher than in the malignant CAO group. The interval between admission and SEMS placement was significantly longer in the malignant TEF group than in the malignant CAO group [14 (10,18) vs. 6 (3, 12) days, P = 0.000)]. The symptomatic improvement was seen in 92 out of 106 patients immediately after the SEMS placement.…”

“…Patients with malignant CAO or TEF could present with dyspnea, hemoptysis, fever, cough, or pneumonia, resulting in a poor prognosis (3)(4)(5)(6)(7). Self-expanding metallic stent (SEMS) is a palliative therapy for malignant CAO and malignant TEF patients, rapidly relieving the symptoms and improving quality of life but not prolonging survival (8)(9)(10)(11). Despite this, many malignant CAO or TEF patients continue to experience disease progression and even death within a short period after SEMS placement (12).…”

Overview of malignant central airway obstruction

“…While the risks of bronchoscopic therapies for management of MCAO are not insignificant, these interventions have shown clear physiologic, symptomatic, and survival benefits for patients ( 11 , 22 , 32 , 44 , 75 - 78 ). Flow volume loops post-airway stenting have been shown to return to near normal in tracheal, bronchial, and carinal stenosis.…”