Biliary stenting in advanced malignancy: an analysis of predictive factors for survival

Abstract

PurposeStenting of the biliary tree is a common palliative procedure to relieve obstructive jaundice in advanced malignancy. Although effective in relief of biliary obstruction and palliation of symptoms, little information is available on predictive factors for survival post-procedure. This retrospective study sought to assess factors influencing post-procedure survival in cancer patients after biliary stenting.MethodsCase notes of all patients from a regional academic cancer center, who underwent biliary stenting for obstructive jaundice related to malignancy during 2008 and 2009 were reviewed. We collected epidemiological, biochemical, treatment and survival data on all patients. We used Kaplan–Meyer analysis to assess survival from day of first biliary stenting (adjusted for cancer types), and the Cox proportional hazards model for univariate and multivariate analysis.ResultsOne hundred and ninety-four patients were included in the final analysis. Most cases were related to pancreatic cancer or cholangiocarcinoma (89 and 46 cases respectively). Median survival for all patients was 143 days. In multivariate analysis serum albumin ≥34 g/L at the time of procedure (hazard ratio 0.573; 95% confidence interval 0.424–0.773, P<0.001) and chemotherapy post-stent (hazard ratio 0.636; 95% confidence interval 0.455–0.889, P=0.008) were two independent prognostic factors predicting a better survival post-stenting. The 30 day mortality post-procedure in the 194 patients was 12%.ConclusionThis study suggests that stenting of the biliary tree in cases of malignant obstruction allows durable palliation of symptoms even in cases where further active chemotherapy treatment is not possible. However, the better outcome observed in patients with albumin ≥34 g/L and those receiving chemotherapy post-stent requires further validation.

Prognostic factors in patients with advanced extrahepatic cholangiocarcinoma

“…Furthermore, post-EBS chemotherapy was found to be an independent prognostic factor to predict a better survival after stenting in a previous study. [9] Since the patients who were able to receive chemotherapy after stenting may live longer than those who did not, we evaluated the chemotherapy suitability to select the patients who benefit more from EBS at diagnosis. Keeping in mind the aggressive biology of BTC, it is highly probable that a significant portion of biliary stentings is unnecessary in these patients.…”

“…Furthermore, post-EBS chemotherapy was found to be an independent prognostic factor to predict a better survival after stenting in a previous study. [9] To our best of knowledge, the evidence is lacking. To answer this critical question, we aimed to investigate the prognostic factors for the OS and the factors predicting the patients eligible for chemotherapy after EBS in ECC.…”

Ictericia obstructiva de causa maligna irresecable tras CPRE fallida: factores predictores del pronóstico: Tratamiento mediante drenaje guiado por ecoendoscopia versus drenaje percutáneo

“…La mayoría de las publicaciones existentes se centran en aspectos técnicos de estos procedimientos y en confirmar la efectividad de estas técnicas para paliar los síntomas del paciente. Existe escasa información disponible de los resultados a largo plazo tras la inserción de la prótesis y sobre los factores que influyen en el éxito del procedimiento, las complicaciones relacionadas con éste y la supervivencia de los pacientes (25). Según lo publicado, el restablecimiento del drenaje biliar aumenta la supervivencia de manera significativa, 4,8-11,8 meses, independientemente de la técnica, con respecto a los pacientes en los que este drenaje fracasa, 1,3-1,8 meses (26)(27)(28) y además mejora su calidad de vida (29).…”

“…No acceso a papila 36 (45) No canulación 27 (33,8) Imposibilidad de drenaje 17 (21,3) Causa de no acceso a papila, n (%) No acceso a papila 14 (43,8) 15 (46,9) No canulación 10 (31,2) 12 (37,5) Imposibilidad de drenaje 8 (25) 5 (15,6) Tabla 20. Causas de fracaso de la CPRE.…”

“…En 2003, se realizó un estudio en el que se evaluó el impacto clínico del drenaje biliar en pacientes con ictericia obstructiva ocasionada por metástasis a nivel del hilio hepático. En este grupo la supervivencia fue de 4 meses (24).Recientemente, en 2014, Afshar et al objetivó una supervivencia de 143 días en un estudio publicado donde se analizaron los factores predictores de supervivencia tras la inserción de prótesis biliares en patología maligna inoperable(25).Existen diversos estudios en los que se analizan diferentes variables a partir de las cuales se determina la supervivencia tras el drenaje biliar: tamaño del tumor(114), variables analíticas(115), complicaciones relacionadas con el procedimiento y éxito clínico de este(116). A continuación se detallan los resultados de algunos de los más recientes:Meller et at(117) publicaron en 2010 un análisis de 25 pacientes con ictericia obstructiva tumoral que fueron sometidos a CTPH y estudiaron los factores predictores de supervivencia.…”