Department of Pulmonology, 541535Coimbra Hospital and Universitary Centre, Coimbra, Portugal.
Department of Pulmonology, 59035Portuguese Institute of Oncology-Porto, Portugal.
Am J Hosp Palliat Care. 2021 Jan;38(1):19-24. doi: 10.1177/1049909120926466. Epub 2020 May 26.
A significant proportion of patients with advanced primary or metastatic intrathoracic malignancy will eventually develop central airway obstruction. The morbidity associated with malignant airway obstruction (MAO) is considerable and the management is difficult. Our aim was to evaluate the outcomes of tracheobronchial stenting in patients with MAO and its role in palliative care.
This retrospective study involved a consecutive case series of patients with advanced cancer with MAO who underwent tracheobronchial stenting between August 2014 and August 2019. The European Cooperative Oncology Group (ECOG) scale was used to evaluate patient functional status before and after tracheobronchial stenting. Univariate survival analysis included Kaplan-Meier curves with Log-Rank test, while Cox regression was used as a multivariate analysis.
We included 28 patients with median age of 55.0 years (interquartile range = 49.3-66.5) and 89.3% male. The most frequent primary tumour was the esophagus followed by lungs. The majority of the patients (75%) expressed immediate symptom relief after stenting and there was a significant improvement in the mean ECOG performance status (PS; = .005). There was no intraprocedure mortality and complications were observed in 6 patients. The median survival after airway stenting was 39.0 days (95% CI = 32.2-45.8) with poorer PS after stent insertion associated with lower overall survival (hazard ratio = 2.3 [95% CI = 1.1-4.9], = .030) on multivariate analysis.
Airway stent is a safe and effective procedure that offers rapid palliation of symptoms with no major complications. Therefore, stent placement should be considered as part of the treatment of patients with terminal cancer.
相当一部分患有晚期原发性或转移性胸内恶性肿瘤的患者最终会发展为中央气道阻塞。恶性气道阻塞（MAO）相关的发病率相当高，且治疗具有挑战性。我们的目的是评估 MAO 患者行气管支气管支架置入术的疗效及其在姑息治疗中的作用。
本回顾性研究纳入了 2014 年 8 月至 2019 年 8 月期间因 MAO 接受气管支气管支架置入术的晚期癌症连续病例系列患者。采用欧洲癌症研究与治疗组织（ECOG）量表评估支架置入前后患者的功能状态。单变量生存分析包括 Kaplan-Meier 曲线和对数秩检验，而 Cox 回归用于多变量分析。
我们纳入了 28 例患者，中位年龄为 55.0 岁（四分位间距= 49.3-66.5），89.3%为男性。最常见的原发肿瘤是食管，其次是肺部。大多数患者（75%）在支架置入后立即缓解症状，ECOG 表现状态（PS）显著改善（ =.005）。无术中死亡，6 例患者出现并发症。气道支架置入后中位生存时间为 39.0 天（95%可信区间= 32.2-45.8），支架置入后 PS 较差与总生存时间较短相关（风险比= 2.3[95%可信区间= 1.1-4.9]， =.030）。
气道支架置入术是一种安全有效的方法，可迅速缓解症状，且无严重并发症。因此，应考虑将支架置入作为晚期癌症患者治疗的一部分。
