Stenting in Non-Small Cell Lung Cancer: How Does It Affect the Outcomes?

Nagla Abdel Karim,Mahmoud Shehata,Sadia Benzequene,Changchun Xie,Mohamed Magdy,Ahmed Mostafa,Ihab Eldessouki,Sinan Khaddasn

doi:10.31557/apjcp.2020.21.1.175

Abstract

Objective:Approximately 30% of lung cancer patients develop central airway obstruction (CAO) that remarkably shortens survival. There is little data about the benefits of stenting within this heterogeneous patient group. Our objective was to review their overall survival (OS) and their risk of hospitalization versus patients who did not have lesions requiring stent placement. Methods:We retrospectively reviewed charts of 171 non-small cell lung cancer (NSCLC) patients who underwent bronchoscopy in the University of Cincinnati Cancer Center from the year 2011 to 2013. Twenty-five patients with advanced lung cancer were evaluated by interventional pulmonology service for endobronchial stent placement for CAO. Eight patients did not require placement of a stent and 17 had obstructive lesions that required stenting by interventional pulmonology. Results:Demographical parameters such as age and gender did not have a significant impact on the risk of hospitalization or OS of both groups of patients, however, those whose lesions did not mandate stent placement had significantly lower odds of hospitalization compared to patients with CAO requiring a stent (OR: 15.913, 95% CI: 1.211-209.068, P = 0.0352). Patients with advanced NSCLC and CAO that required stent placement had an OS of 13.9 m [3.9-19.9 m] compared to an OS of 23.9 m for patients with CAO not requiring a stent. We found out that patients with less severe CAO have lower odds of hospitalization and better OS compared to patients with CAO mandating stent placement. Conclusion:CAO patients with interventional pulmonology (IP) evaluation and management in addition, may have improved OS suggesting that IP consultation might offer both improvement in quality of life and overall survival to patients with advanced NSCLC and CAO.

Highlights

Central airway obstruction (CAO) mainly occurs secondary to malignant lesions and to a lesser extent due to benign lesions
Patients with central airway obstruction (CAO) who did not require stent placement had a lower risk of hospitalization and better overall survival when compared to patients with CAO who needed stent placement
Our results are consistent with previous studies stating that stenting is averting premature death, allowing application of cancer targeted therapy and restoring impending shortened survival to expected life expectancy associated with the underlying malignancy (Ernst et al, 2002; Chhajed et al, 2006)

Summary

Introduction

Central airway obstruction (CAO) mainly occurs secondary to malignant lesions and to a lesser extent due to benign lesions. While many investigators think that it would be unethical to randomize patients with CAO with symptomatic disease to therapeutic procedures, it may be impossible to adopt double-blinding in this population. For these reasons, literature is mainly made up of case series and retrospective analyses. There is not much data about the impact on OS or the risk of hospitalization in CAO patients mandating stent placement compared to those who did not require stenting. While patients with CAO not requiring stent placement were excluded in previous studies, to our knowledge, this is the first study to explore the outcome of patients with two types of obstructive airway lesions based on whether they mandate a stent or not

Materials and Methods

Results

Discussion