Prat F, Chapat O, Ducot B, Ponchon T, Fritsch J, Choury A D, Pelletier G, Buffet C
Service des Maladies du Foie et de l'Appareil Digestif, CHU de Bicêtre, Le Kremlin-Bicêtre, France.
Gut. 1998 Jan;42(1):76-80. doi: 10.1136/gut.42.1.76.
Stenting is the treatment of choice for inoperable malignant strictures of the common bile duct. Criteria for the choice of stents (plastic versus metallic) remain controversial because predicting survival is difficult.
To define prognostic factors in order to improve the cost effectiveness of endoscopic palliation.
One hundred and one patients were included in a prospective trial. Seven prognostic variables for survival were analysed (age, sex, bilirubinaemia, weight loss, presence of liver metastases, and tumour histology and size). All patients were followed until death or at least one year after inclusion. By the end of the study, 81 (80.2%) patients had died.
In univariate analysis, the variables associated with survival were weight loss (p < 0.05) and tumour size (p < 0.01). By multivariate analysis, tumour size was the only independent prognostic factor (p < 0.05). A threshold of 30 mm at diagnosis distinguished two survival profiles: the median survival of patients with a tumour greater than 30 mm was 3.2 months, whereas it was 6.6 months for patients with a tumour less than 30 mm (p < 0.001).
A practical strategy could be based on tumour size at diagnosis: a metal stent should be systematically chosen for patients with an inoperable tumour smaller than 30 mm, while larger tumours are efficiently palliated by a plastic stent.
支架置入术是无法手术切除的胆总管恶性狭窄的首选治疗方法。由于预测生存期困难，支架（塑料支架与金属支架）选择标准仍存在争议。
确定预后因素以提高内镜姑息治疗的成本效益。
101例患者纳入一项前瞻性试验。分析了7个生存预后变量（年龄、性别、胆红素血症、体重减轻、肝转移情况、肿瘤组织学类型及大小）。所有患者随访至死亡或纳入研究后至少1年。研究结束时，81例（80.2%）患者死亡。
单因素分析中，与生存相关的变量为体重减轻（p<0.05）和肿瘤大小（p<0.01）。多因素分析显示，肿瘤大小是唯一的独立预后因素（p<0.05）。诊断时肿瘤大小30mm的阈值区分出两种生存情况：肿瘤大于30mm患者的中位生存期为3.2个月，而肿瘤小于30mm患者的中位生存期为6.6个月（p<0.001）。
一种实用策略可基于诊断时的肿瘤大小：对于无法手术切除且肿瘤小于30mm的患者应系统性选择金属支架，而较大肿瘤采用塑料支架可有效姑息治疗。
