Predictors of survival and technical success of bronchoscopic interventions in malignant airway obstruction

Journal of Thoracic Disease

article

Cláudia Freitas¹  Mariana Serino¹  Catarina Cardoso¹  Sandra Saleiro³  Ana Paula Vaz⁴  Hélder Novais-Bastos¹  António Morais¹  Adriana Magalhães¹  Gabriela Fernandes¹ 

[1] Department of Pulmonology, Centro Hospitalar e Universitário São João;Faculty of Medicine, University of Porto;Department of Pulmonology, Instituto Português de Oncologia do Porto Francisco Gentil;Department of Pulmonology, Unidade de Saúde Local de Matosinhos – Hospital Pedro Hispano;Instituto de Investigação e Inovação em Saúde, i3S, Instituto de Biologia Molecular e Celular, IBMC, University of Porto

关键词: Malignant airway obstruction (MAO);    interventional bronchoscopy;    airway stenting;    cancer care;    survival;   

DOI  :  10.21037/jtd-21-1393

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Background: Malignant airway obstruction (MAO) leads to quality of life impairment and increased mortality. Interventional bronchoscopy allows airway patency restoring, leading to a better survival. We investigated predictors of survival and successful bronchoscopic intervention among MAO patients. Methods: This observational prospective study enrolled 100 patients who were newly diagnosed with MAO. Survival was estimated with Kaplan-Meier method and curves compared by log-rank test. Multivariate analyses were performed using Cox proportional hazard models. Univariate and multivariate logistic regression were used for odds ratio calculation. Results: A proportion of 73% of the patients were male with a median age was 62.5 years (range, 21–88 years). Lung cancer was the most common primary malignancy (74%). The majority had single (61%), endoluminal (62%) lesions and were classified as grade III in Myer Cotton scale (57%). The most used techniques comprised mechanical debulking (n=81) and laser therapy (n=68). Twenty-two airway stents were placed. While eleven patients were considered untreatable, technical success was achieved in 78%. Haemorrhage was the most common acute complication (16%). No deaths occurred as a result of the procedure. Median global survival was 8 months. Adjusting for age and Eastern Cooperative Oncology Group Performance Status (ECOG), extrinsic compression or mixed airway obstructions [hazard ratio (HR) =2.075; P=0.012], successful bronchoscopic intervention (HR =0.468; P=0.025) and initiation of cancer treatment (HR =0.373; P=0.006) were independent predictors of survival. The absence of distal airway patency on thoracic CT was independently associated with failure of the intervention [odds ratio (OR) =0.013; P<0.001]. Conclusions: Interventional bronchoscopy has proven to be an efficient and safe strategy to manage MAO patients. The patients who benefit the most in terms of survival are those with purely endoluminal lesions, in whom technical success was achieved and those whose cancer-specific treatment was initiated. Distal airway patency on thoracic CT predicts the technical success of bronchoscopic intervention.

【 授权许可】

Unknown