Prognostic Factors Associated With Interventional Bronchoscopy in Lung Cancer

Abstract

Interventional bronchoscopy is an effective procedure for malignant central airway obstruction, although its indications are poorly defined and its benefits difficult to predict. The purpose of the study was to identify the patients' or the disease's characteristics that are correlated with survival to enable clinicians to identify the best indications. We retrospectively studied the data from 204 patients treated between 2004 and 2010. We analyzed survival times according to the patients' or disease's characteristics, and identified homogeneous risks using classification and regression trees. Reduced survival was associated with a high American Society of Anesthesiologists score (13, 5.9, and 2.9 months for scores of 2, 3, and 4, respectively; p = 0.0005), nonsquamous cell histology (median survival, 6.3 months; p = 0.007), metastatic tumors (9.2 and 6.2 months for stage IIIA and IIIB, respectively, versus 3 months for stage IV; p = 0.0002), and for patients who had not received a specific treatment (median survival, 8.6 versus 3.2 months for untreated patients; p < 0.0001). Classification and regression trees segmentation identified five distinct groups of patients. Patients receiving a specific treatment for squamous cell carcinoma derived the best survival (median, 13 months; p < 0.0001), whereas patients with an American Society of Anesthesiologists score of 4 treated for large cell cancer or adenocarcinoma and metastatic patients who did not receive any specific treatment had the worst survival (0.8 months and 2.7 months, respectively; p < 0.0001). Interventional bronchoscopy is a safe and effective procedure that should be integrated into a multimodal therapy for selected patients.