Stenting for Unresectable Esophageal Cancer: Does It Improve Survival?

Abstract

Background: Self-expanding metal stents provide patients with non-resectable esophageal cancer immediate and significant relief from dysphagia. The impact of stenting on the survival of such patients is not known. Methods: We studied all patients diagnosed with esophageal cancer at the Houston VAMC between 1998 and 2005. Those with any of the following characteristics were excluded: female sex, early stage of disease (stages I and II), treatment outside the VA, and surgical resection. Using univariate and multivariate analyses, we compared those who received stents to those who did not with regard to age, race, comorbidity score, pathology, disease stage, baseline body mass index (BMI), serum albumin (baseline and last recorded values), and treatment with chemo/radio therapy (CRT). Cox proportional hazard model was used to examine the effect of potential determinants on survival; hazard rates (HR) and 95% confidence intervals were reported. Results: Seventy-three patients were included in the final analysis. Of those 19 (26.0 %) received stents. Mean age, race, comorbidity score, pathology, disease stage, baseline BMI, and serum albumin at diagnosis were similar in the two groups (Table). The last recorded albumin and the receipt of CRT were lower in the stent group (Table). The overall median survival was 123 days (95% CI: 92-197). Median survival was similar in both groups (120 vs. 123 days, p = 0.6). Comorbidity score and pathology had no influence on survival. Survival was significantly higher in patients with a higher baseline serum albumin (p < 0.02), a higher baseline body mass index (p = 0.02) and in those receiving CRT (p < 0.0001). In the Cox survival analysis, the predictors of improved survival were early disease stage (HR = 0.5 (95% CI: 0.3-0.9) for stage III vs. stage IV), receipt of CRT (HR = 0.3 (95% CI: 0.1-0.7)), high baseline BMI (HR = 0.5 (95% CI:0.3-0.9), and high baseline albumin (HR = 0.5 (95% CI:0.3-0.9)), but not stenting (HR = 0.8 (95% CI: 0.4-1.6)). Conclusion: In patients with unresectable carcinoma of the esophagus, palliative stenting does not prolong survival. Baseline nutritional status and receiving chemo/radio therapy are associated with improved survival. Table Stent No Stent P Race (White) 12 (63.2%) 34 (63.0%) 0.5 Comorbidity (≥3) 5 (26.3%) 15 (27.8%) 0.8 BMI (≥25) 7 (38.9%) 20 (47.6%) 0.5 Baseline Albumin (mean) 3.3 3.3 0.9 Last Albumin (mean) 2.1 2.6 0.004 Path (Adeno) 10 (52.6%) 27 (50.0%) 0.7 Stage(IV) 13 (68.4%) 38 (70.4%) 0.8 CRT 11 (57.9%) 44 (81.5%) 0.04 Open table in a new tab