Survival And Prognostic Factors For Airway Stent Placement In Patients With Malignant Central Airway Obstruction

Objective Central airway obstruction caused by malignant tumors is a clinically common and critical condition.The short-term efficacy of emergency interventional therapy for airway stents is significant,but the long-term curative effect is not yet clear.The purpose of this study was to observe the survival of airway stenting in patients with malignant central airway stenosis and to explore the factors that influence its prognosis in order to understand and improve the treatment and prognosis of the disease.Methods From February 2003 to June 2017,108 patients with malignant central airway stenosis who received airway stenting at the First Affiliated Hospital of Soochow University were followed up for a long period of time.Patients’ survival time was followed up,and the clinical data of patients were retrospectively collected.Data analysis related factors that influence prognosis.Kaplan-Meier method was used to calculate the survival rate.The Log-Rank method was used for univariate survival analysis.The Cox regression model was used for multivariate survival analysis.Results Among the 108 patients with airway stenting for malignant central airway obstruction,there were 50 cases of esophageal cancer(46.3%),34 cases of lung cancer(31.5%),11 cases of thyroid cancers(10.2%),2 cases of Intratracheal adenoid cystic carcinoma(1.8%),3 cases of mediastinal malignancies with unknown primary tumor(2.8%),2 cases of thymic carcinoma(1.8%),2 cases of laryngeal carcinoma(1.8%),and 2 cases of rectal cancer(1.8%)),1 case of nasopharyngeal carcinoma(0.9%),1 case of soft tissue giant cell tumor of the neck(0.9%).The median survival time after first airway stent placement was4.1 months(range from 0.1 to 66.2 months)and the survival rates of 1 month,3 months,6months,9 months and 12 months were 90.7%,63.0%,32.4%,16.7% and 6.5%,respectively.Univariate analysis showed that the effect of pathological staging,prior-procedural history of radiotherapy,prior-procedural history of chemotherapy,neutrophil lymphocyte ratio(NLR),serum lactate dehydrogenase(LDH)level,site of stent placement,invasive carina,prior-procedural eastern cooperative oncology group performance status(ECOG PS)scores,post-procedural reinterventional therapies and adjuvant treatments were statistically difference(P<0.05)on the prognosis of these patients.Multivariate analysis showed that LDH levels,invasive carina,prior-procedural ECOG PS scores,and post-procedural adjuvant treatments were independent factors influencing the outcome of patients with airway stenting for malignant central airway obstruction(P<0.05).The placement of airway stent could improve prognosis in patients with selected conditions,such as LDH≤250u/L,non-infiltration of carina,prior-procedural lower ECOG PS score(0to 2 score)and available post-procedural additional treatment of chest radiotherapy or systemic chemotherapy or comprehensive treatment.Conclusions1.Esophageal cancer and lung cancer were the most common cause of patients with malignant central airway obstruction after airway stenting,accounting for 46.3% and31.5%,respectively.2.The median survival time after first airway stenting was 4.1 months,and the 1-,3-,6-,9-,and 12-month survival rates were 90.7%,63.0%,32.4%,16.7 % and 6.5%,respectively.3.LDH level,invasive carina,prior-procedural ECOG PS score and post-procedural adjuvant treatments were independent factors influencing the prognosis of these patients.