Impact of anticancer treatment on recurrent obstruction in covered metallic stents for malignant biliary obstruction View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2013-01-25

AUTHORS

Yousuke Nakai, Hiroyuki Isayama, Tsuyoshi Mukai, Takao Itoi, Iruru Maetani, Hiroshi Kawakami, Ichiro Yasuda, Hiroyuki Maguchi, Shomei Ryozawa, Keiji Hanada, Osamu Hasebe, Kei Ito, Hiorofumi Kawamoto, Hitoshi Mochizuki, Yoshinori Igarashi, Atsushi Irisawa, Tamito Sasaki, Osamu Togawa, Taro Hara, Hideki Kamada, Nobuo Toda, Tsuyoshi Hamada, Hirofumi Kogure

ABSTRACT

BackgroundIn patients with unresectable malignant biliary obstruction (MBO), anticancer treatment is often administered. The impact of anticancer treatment on recurrent biliary obstruction in covered self-expandable metallic stents (SEMS) has not been fully elucidated.MethodsData on 279 patients enrolled in a multicenter prospective cohort study of two different covered SEMS for distal MBO, WATCH study (141 partially covered WallFlex stents and 138 partially covered Wallstents) were retrospectively analyzed. The rates and causes of recurrent biliary obstruction (stent occlusion or migration) were compared between anticancer treatment group (n = 173) and best supportive care alone (BSC) group (n = 106). Cumulative time and prognostic factors for recurrent biliary obstruction were analyzed, using a proportional hazards model with death without recurrent biliary obstruction as a competing risk.ResultsThe overall rate (43 vs. 25 %, P = 0.002) and the cumulative incidence (16.1 vs. 8.2, 27.9 vs. 18.9 and 44.1 vs. 26.6 % at 3, 6 and 12 months, P = 0.030 by Gray’s test) of recurrent biliary obstruction were significantly higher in anticancer treatment group compared with BSC group. The multivariate analysis revealed anticancer treatment [subdistribution hazard ratio (SHR) 1.93, P = 0.007) as well as the use of a partially covered WallFlex stent (SHR 0.65, P = 0.049) as prognostic factors.ConclusionsAnticancer treatment was a risk factor for recurrent biliary obstruction in covered SEMS for distal MBO. The superiority of a partially covered WallFlex stent was again confirmed in this competing risk analysis; UMIN-CTR: UMIN000002293. More... »

PAGES

1293-1299

Journal

TITLE

Journal of Gastroenterology

ISSUE

11

VOLUME

48

Author Affiliations

  • Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
  • Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
  • Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
  • Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
  • Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
  • First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
  • Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
  • Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
  • Center of Gastroenterology, Onomichi General Hospital, Onomichi, Japan
  • Department of Gastroenterology, Nagano Municipal Hospital, Nagano, Japan
  • Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
  • Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
  • Department of Gastroenterology, Yamanashi Prefectural Central Hospital, Kofu, Japan
  • Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
  • Department of Gastroenterology, Preparatory office for Aizu Medical Center, Fukushima Medical University School of Medicine, Fukushima, Japan
  • Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
  • Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
  • Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan
  • Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Kagawa, Japan
  • Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00535-013-0749-6

    DOI

    http://dx.doi.org/10.1007/s00535-013-0749-6

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1034101732

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/23354624


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