Qian Hui-Wen, Zhang Ping, Wang Xin, Zhang Yi, Li Juan, Zhong En-Jian, Ji Shun-Dong, Li Jing, Zou Li-Rong, Xu Sheng, Zhang Yong-Hong, Huang Jian-An, Yang Jin-Ming, Zhong Chong-Ke, Ji Cheng
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Respiratory Medicine, The Shangrao People's Hospital, Shangrao, China.
J Thorac Dis. 2021 Jan;13(1):39-49. doi: 10.21037/jtd-20-1520.
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.
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.
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.
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.
关于气道支架的有效性和并发症已有许多研究，但很少有研究关注影响支架置入后生存的因素。本研究旨在评估气道金属支架置入后恶性中央气道阻塞（MCAO）患者生存的相关因素。
回顾性分析2003年2月至2017年6月在中国苏州大学附属第一医院接受支架置入的成年MCAO患者的临床资料。采用Log-rank检验比较生存率。使用多变量Cox风险回归模型确定潜在的预后因素。
本研究共纳入102例MCAO患者。这些患者气道金属支架置入后的中位生存时间为4.1个月。多变量分析显示，支架置入后接受放疗[风险比（HR）0.554；95%置信区间（CI）：0.308 - 0.999]或放化疗（HR 0.251；95% CI：0.126 - 0.499）的MCAO患者预后较好。然而，支架置入前ECOG PS≥3分（HR 2.193；95% CI：1.364 - 3.526）以及在气管和主支气管均放置支架（HR 2.458；95% CI：1.384 - 4.366）与较差的生存相关。
在我们的研究结果中，气道金属支架置入后MCAO患者的生存与支架置入前的ECOG PS评分、支架置入部位有关，并且我们首次提出支架置入后有机会接受放疗或放化疗有助于改善预后。
