Hodo Yuji, Takatori Hajime, Komura Takuya, Asahina Yoshiro, Chiba Tomoyoshi, Takabatake Hisashi, Hasatani Kenkei, Nishino Ryuhei, Yano Masaaki, Takata Yoshiko, Suda Tsuyoshi, Shugo Haruhiko, Nakanishi Hiroyoshi, Yamada Kazutoshi, Miwa Kazuhiro, Kaji Kiichiro, Nishitani Masaki, Miyazawa Masaki, Yamashita Taro
Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Ishikawa, Japan.
Department of Endoscopy, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa 921-8641, Japan.
Therap Adv Gastroenterol. 2023 Mar 6;16:17562848231156279. doi: 10.1177/17562848231156279. eCollection 2023.
Endoscopic gastroduodenal stent (GDS) placement is widely used as a safe and effective method to rapidly improve gastrointestinal symptoms of malignant gastric outlet obstruction (MGOO). While previous studies reported the utility of chemotherapy after GDS placement for prognosis improvement, they did not fully address the issue of immortal time bias.
To examine the association between prognosis and clinical course following endoscopic GDS placement, using a time-dependent analysis.
Multicenter retrospective cohort study.
This study included 216 MGOO patients who underwent GDS placement between April 2010 and August 2020. Data of patient baseline characteristics, including age, gender, cancer type, performance status (PS), GDS type and length, GDS placement location, gastric outlet obstruction scoring system (GOOSS) score, and history of chemotherapy before GDS were collected. The clinical course following GDS placement was evaluated by GOOSS score, stent dysfunction, cholangitis, and chemotherapy. A Cox proportional hazards model was used to identify prognostic factors after GDS placement. Stent dysfunction, post-stent cholangitis, and post-stent chemotherapy were analyzed as time-dependent covariates.
Mean GOOSS scores before and after GDS were 0.7 and 2.4, respectively, with significant improvement after GDS placement ( < 0.001). The median survival time after GDS placement was 79 [95% confidence interval (CI): 68-103] days. In multivariate Cox proportional hazards model with time-dependent covariates, PS 0-1 [hazard ratio (HR): 0.55, 95% CI: 0.40-0.75; < 0.001], ascites (HR: 1.45, 95% CI: 1.04-2.01; = 0.028), metastasis (HR: 1.84, 95% CI: 1.31-2.58; < 0.001), post-stent cholangitis (HR: 2.38, 95% CI: 1.37-4.15; = 0.002), and post-stent chemotherapy (HR: 0.01, 95% CI: 0.002-0.10; < 0.001) significantly affected prognosis after GDS placement.
Post-stent cholangitis and tolerability to receive chemotherapy after GDS placement influenced prognosis in MGOO patients.
内镜下胃十二指肠支架（GDS）置入术作为一种安全有效的方法，被广泛用于快速改善恶性胃出口梗阻（MGOO）的胃肠道症状。虽然先前的研究报道了GDS置入术后化疗对改善预后的作用，但它们并未充分解决不朽时间偏倚的问题。
采用时间依赖性分析方法，研究内镜下GDS置入术后的预后与临床病程之间的关联。
多中心回顾性队列研究。
本研究纳入了2010年4月至2020年8月期间接受GDS置入术的216例MGOO患者。收集患者的基线特征数据，包括年龄、性别、癌症类型、体能状态（PS）、GDS类型和长度、GDS置入位置、胃出口梗阻评分系统（GOOSS）评分以及GDS置入术前的化疗史。通过GOOSS评分、支架功能障碍、胆管炎和化疗来评估GDS置入术后的临床病程。采用Cox比例风险模型确定GDS置入术后的预后因素。将支架功能障碍、支架置入术后胆管炎和支架置入术后化疗作为时间依赖性协变量进行分析。
GDS置入术前和术后的平均GOOSS评分分别为0.7和2.4，GDS置入术后有显著改善（<0.001）。GDS置入术后的中位生存时间为79天[95%置信区间（CI）：68 - 103]。在带有时间依赖性协变量的多变量Cox比例风险模型中，PS 0 - 1[风险比（HR）：0.55，95% CI：0.40 - 0.75；<0.001]、腹水（HR：1.45，95% CI：1.04 - 2.01；=0.028）、转移（HR：1.84，95% CI：1.31 - 2.58；<0.001）、支架置入术后胆管炎（HR：2.38，95% CI：1.37 - 4.15；=0.002）和支架置入术后化疗（HR：0.01，95% CI：0.002 - 0.10；<0.001）对GDS置入术后的预后有显著影响。
支架置入术后胆管炎以及GDS置入术后接受化疗的耐受性影响了MGOO患者的预后。
