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

2013-11

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

BACKGROUND: In 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. METHODS: Data 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. RESULTS: The 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. CONCLUSIONS: Anticancer 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

References to SciGraph publications

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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