Abstract
BackgroundMalignant central airway obstruction (MCAO) occurs in 20–30% of patients with primary pulmonary malignancy. Although bronchoscopic intervention is widely performed to treat MCAO, little data exist on the prognosis of interventional bronchoscopy. Therefore, we evaluated the clinical outcomes and prognostic factors of bronchoscopic interventions in patients with MCAO due to primary pulmonary malignancy.MethodsThis retrospective study was conducted at a university hospital and included 224 patients who received interventional bronchoscopy from 2004 to 2017, excluding patients with salivary gland-type tumor. A multivariable Cox proportional hazard regression analysis was used to identify independent prognostic factors associated with survival after the first bronchoscopic intervention.ResultsAmong 224 patients, 191 (85.3%) were males, and the median age was 63 years. The most common histological type of malignancy was squamous cell carcinoma (71.0%). Technical success was achieved in 93.7% of patients. Acute complications and procedure-related death occurred in 15.6 and 1.3% of patients, respectively. The median survival time was 7.0 months, and survival rates at one year and two years were 39.7 and 28.3%, respectively. Poor survival was associated with underlying chronic pulmonary disease, poor performance status, extended lesion, extrinsic or mixed lesion, and MCAO due to disease progression and not receiving adjuvant treatment after bronchoscopic intervention.ConclusionsInterventional bronchoscopy could be a safe and effective procedure for patients who have MCAO due to primary pulmonary malignancy. In addition, we found several prognostic factors for poor survival after intervention, which will help clinicians determine the best candidates for bronchoscopic intervention.
Highlights
Malignant central airway obstruction (MCAO) occurs in 20–30% of patients with primary pulmonary malignancy
Malignant central airway obstruction (MCAO), which is defined as ≥50% occlusion of the crosssectional area of the central airway, occurs in 20–30% of patients with primary pulmonary malignancy caused by endoluminal metastasis or extrinsic compression of bulky lymphadenopathy [7]
To the best of our knowledge, few articles have reported the prognostic factors associated with survival after bronchoscopic intervention
Summary
Malignant central airway obstruction (MCAO) occurs in 20–30% of patients with primary pulmonary malignancy. We evaluated the clinical outcomes and prognostic factors of bronchoscopic interventions in patients with MCAO due to primary pulmonary malignancy. Central airway obstruction is one of the major complications and causes hemoptysis, atelectasis, and obstructive pneumonia These patients experience disability in daily activities and are at increased risk of repeated hospitalization for respiratory failure [6]. The effects of chemotherapy or radiation therapy may take a long time to relieve the MCAO [9] Bronchoscopic interventions, such as mechanical debulking, laser cauterization, and stent placement, can immediately relieve symptoms related to airway obstruction and improve quality of life [10]. To the best of our knowledge, few articles have reported the prognostic factors associated with survival after bronchoscopic intervention
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