Mallow Christopher, Thiboutot Jeffrey, Semaan Roy, Hayes Margaret M, Hales Russell, Ram Ashwin, Feller-Kopman David, Lee Hans, Yarmus Lonny
Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Respirology. 2018 Mar 12. doi: 10.1111/resp.13292.
Malignant airway obstruction (MAO), a common complication of patients with advanced lung cancer, causes debilitating dyspnoea and poor quality of life. Two common interventions used in the treatment of MAO include bronchoscopy with airway stenting and external beam radiotherapy (EBRT). Data are limited regarding their clinical effectiveness and overall effect on survival.
A retrospective chart review of patients treated with airway stenting and/or EBRT at the Johns Hopkins Hospital for MAO between July 2010 and January 2017 was reviewed. Demographics, performance status, cancer histology, therapeutic intervention and date of death were recorded. Survival was calculated using cox regression analysis.
Of the 606 patients who were treated for MAO, 237 were identified as having MAO and included in the study. Sixty-eight patients underwent rigid bronchoscopy and stenting, 102 EBRT and 67 a combined approach. Patients who underwent stenting hand an increased hazard ratio (HR) of death in comparison to those who received combination therapy (HR: 2.12, 95% CI: 1.02, 4.39), while there was a trend towards significance in the EBRT alone group in comparison to the combination therapy group (HR: 1.62, 95% CI: 0.93, 2.83).
In this retrospective analysis, combination therapy with stenting and EBRT led to better survival in comparison to stenting or EBRT alone. Prospective cohort trials are needed to confirm these results.
恶性气道阻塞（MAO）是晚期肺癌患者的常见并发症，可导致使人虚弱的呼吸困难和生活质量下降。治疗MAO常用的两种干预措施包括支气管镜下气道支架置入术和外照射放疗（EBRT）。关于它们的临床疗效及对生存的总体影响的数据有限。
回顾性分析2010年7月至2017年1月在约翰霍普金斯医院接受气道支架置入术和/或EBRT治疗MAO的患者病历。记录人口统计学资料、体能状态、癌症组织学类型、治疗干预措施及死亡日期。采用Cox回归分析计算生存率。
在606例接受MAO治疗的患者中，237例被确定为患有MAO并纳入研究。68例患者接受了硬质支气管镜检查及支架置入术，102例接受了EBRT，67例接受了联合治疗。与接受联合治疗的患者相比，接受支架置入术的患者死亡风险比（HR）增加（HR：2.12，95%可信区间：1.02，4.39），而单纯EBRT组与联合治疗组相比有显著差异趋势（HR：1.62，95%可信区间：0.93，2.83）。
在这项回顾性分析中，与单纯支架置入术或EBRT相比，支架置入术与EBRT联合治疗可提高生存率。需要进行前瞻性队列试验来证实这些结果。
