Impact of biliary stent-related events in patients diagnosed with advanced pancreatobiliary tumours receiving palliative chemotherapy.

Autor:	Lamarca A; Angela Lamarca, Christina Rigby, Mairéad G McNamara, Richard A Hubner, Juan W Valle, Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, Manchester, United Kingdom., Rigby C; Angela Lamarca, Christina Rigby, Mairéad G McNamara, Richard A Hubner, Juan W Valle, Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, Manchester, United Kingdom., McNamara MG; Angela Lamarca, Christina Rigby, Mairéad G McNamara, Richard A Hubner, Juan W Valle, Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, Manchester, United Kingdom., Hubner RA; Angela Lamarca, Christina Rigby, Mairéad G McNamara, Richard A Hubner, Juan W Valle, Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, Manchester, United Kingdom., Valle JW; Angela Lamarca, Christina Rigby, Mairéad G McNamara, Richard A Hubner, Juan W Valle, Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, Manchester, United Kingdom.
Jazyk:	angličtina
Zdroj:	World journal of gastroenterology [World J Gastroenterol] 2016 Jul 14; Vol. 22 (26), pp. 6065-75.
DOI:	10.3748/wjg.v22.i26.6065
Abstrakt:	Aim: To determine the impact (morbidity/mortality) of biliary stent-related events (SRE) (cholangitis or stent obstruction) in chemotherapy-treated pancreatico-biliary patients. Methods: All consecutive patients with advanced pancreatobiliary cancer and a biliary stent in-situ prior to starting palliative chemotherapy were identified retrospectively from local electronic case-note records (Jan 13 to Jan 15). The primary end-point was SRE rate and the time-to-SRE (defined as time from first stenting before chemotherapy to date of SRE). Progression-free survival and overall survival were measured from the time of starting chemotherapy. Kaplan-Meier, Cox and Fine-Gray regression (univariate and multivariable) analyses were employed, as appropriate. For the analysis of time-to-SRE, death was considered as a competing event. Results: Ninety-six out of 693 screened patients were eligible; 89% had a metal stent (the remainder were plastic). The median time of follow-up was 9.6 mo (range 2.2 to 26.4). Forty-one patients (43%) developed a SRE during follow-up [cholangitis (39%), stent obstruction (29%), both (32%)]. There were no significant differences in baseline characteristics between the SRE group and no-SRE groups. Recorded SRE-consequences were: none (37%), chemotherapy delay (24%), discontinuation (17%) and death (22%). The median time-to-SRE was 4.4 mo (95%CI: 3.6-5.5). Patients with severe comorbidities (P < 0.001) and patients with ≥ 2 baseline stents/biliary procedures [HR = 2.3 (95%CI: 1.2-4.44), P = 0.010] had a shorter time-to-SRE on multivariable analysis. Stage was an independent prognostic factor for overall survival (P = 0.029) in the multivariable analysis adjusted for primary tumour site, performance status and development of SRE (SRE group vs no-SRE group). Conclusion: SREs are common and impact on patient's morbidity. Our results highlight the need for prospective studies exploring the role of prophylactic strategies to prevent/delay SREs.
Databáze:	MEDLINE
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