Bai Yang, Zhan Ke, Chi Jing, Jiang JinYue, Li Shuang, Yin Yuting, Li Yishi, Guo Shuliang
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Med (Lausanne). 2022 Jul 7;9:902488. doi: 10.3389/fmed.2022.902488. eCollection 2022.
Self-expanding metallic stent (SEMS) is a palliative therapy for patients with malignant central airway obstruction (CAO) or tracheoesophageal fistula (TEF). Despite this, many patients experience death shortly after SEMS placement.
We aimed to investigate the effect of SEMS on the palliative treatment between malignant CAO and malignant TEF patients and investigate the associated prognostic factors of the 3-month survival.
We performed a single-center, retrospective study of malignant CAO or TEF patients receiving SEMS placement. Clinical data were collected using the standardized data abstraction forms. Data were analyzed using SPSS 22.0. A two-sided -value <0.05 was statistically significant.
106 malignant patients (82 CAO and 24 TEF) receiving SEMS placement were included. The body mass index (BMI), hemoglobin levels, and albumin levels in the malignant TEF group were lower than in the malignant CAO group (all < 0.05). The procalcitonin levels, C-reactive protein levels, and the proportion of inflammatory lesions were higher in the malignant TEF group than in the malignant CAO group (all < 0.05). The proportion of symptomatic improvement after the SEMS placement was 97.6% in the malignant CAO group, whereas 50.0% in the malignant TEF group, with a significant difference ( = 0.000). Three months after SEMS placement, the survival rate at was 67.0%, significantly lower in the malignant TEF group than in the malignant CAO group (45.8% vs. 73.2%, = 0.013). Multivariate analysis revealed that BMI [odds ratio (OR) = 1.841, 95% certificated interval (CI) (1.155-2.935), = 0.010] and neutrophil percentage [OR = 0.936, 95% CI (0.883-0.993), = 0.027] were the independent risk factors for patients who survived three months after SEMS placement.
We observed symptom improvement in malignant CAO and TEF patients after SEMS placement. The survival rate in malignant TEF patients after SEMS placement was low, probably due to aspiration pneumonitis and malnutrition. Therefore, we recommend more aggressive treatment modalities in patients with malignant TEF, such as strong antibiotics, nutrition support, and strategic ventilation. More studies are needed to investigate the prognostic factors in patients with malignant airway disorders receiving SEMS placement.
自膨式金属支架（SEMS）是治疗恶性中央气道阻塞（CAO）或气管食管瘘（TEF）患者的一种姑息治疗方法。尽管如此，许多患者在放置SEMS后不久便死亡。
我们旨在研究SEMS对恶性CAO和恶性TEF患者姑息治疗的效果，并调查3个月生存率的相关预后因素。
我们对接受SEMS置入的恶性CAO或TEF患者进行了一项单中心回顾性研究。使用标准化数据提取表收集临床数据。数据采用SPSS 22.0进行分析。双侧P值<0.05具有统计学意义。
纳入106例接受SEMS置入的恶性患者（82例CAO和24例TEF）。恶性TEF组的体重指数（BMI）、血红蛋白水平和白蛋白水平低于恶性CAO组（均P<0.05）。恶性TEF组的降钙素原水平、C反应蛋白水平和炎症病变比例高于恶性CAO组（均P<0.05）。SEMS置入后症状改善的比例在恶性CAO组为97.6%，而在恶性TEF组为50.0%，差异有统计学意义（P = 0.000）。SEMS置入3个月后，总体生存率为67.0%，恶性TEF组显著低于恶性CAO组（45.8%对73.2%，P = 0.013）。多因素分析显示，BMI[比值比（OR）=1.841，95%可信区间（CI）（1.155 - 2.935），P = 0.01]和中性粒细胞百分比[OR = 0.936，95%CI（0.883 - 0.993），P = 0.027]是SEMS置入后存活3个月患者 的独立危险因素。
我们观察到SEMS置入后恶性CAO和TEF患者症状有所改善。SEMS置入后恶性TEF患者的生存率较低，可能是由于吸入性肺炎和营养不良。因此，我们建议对恶性TEF患者采用更积极的治疗方式，如强效抗生素、营养支持和策略性通气。需要更多研究来调查接受SEMS置入的恶性气道疾病患者的预后因素。
