Tu1204 PERFORMANCE STATUS IS A PREDICTIVE FACTOR OF DYSPHAGIA IMPROVEMENT AFTER ESOPHAGEAL STENTING IN PATIENTS WITH MALIGNANT ESOPHAGEAL STRICTURES AND FISTULAS

Abstract

Malignant strictures and fistulas of the esophagus adversely affect quality of life (QOL) and prognosis, and stenting is considered as a useful therapy for improving QOL. However, the predictive factors for improving dysphagia after esophageal stenting are unclear. Therefore, we performed a retrospective cohort study of patients with esophageal malignant strictures who underwent stenting and investigated the factors for dysphagia improvement after stenting. A total of 24 patients with malignant esophageal strictures were treated with a self-expandable metallic stent over a period of 5 years and 6 months. The aim of this study was improvement in the dysphagia score. We divided the patients into dysphagia improved and non-improved groups after esophageal stenting. We evaluated the sex, age, cause of stenting (primary or non-primary esophageal cancers), prior treatments, such as chemotherapy and radiation, type of esophageal stents (covered or non-covered), dysphagia score before stenting, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) of the patients before stenting. Student’s t-test was used for continuous variables, and Fisher’s exact test was used for categorical variables. Factors with a P-value <0.6 were included and evaluated using a multiple logistic regression model. Statistical significance was defined as a P-value <0.05. The dysphagia score improved in 15 patients and did not improve in 9 patients. The numbers of patients with primary and non-primary lesions were 12 and 12, respectively. The reasons for stenting were severe strictures in 20 patients and esophageal fistulas in 4 patients. There were no significant differences in any factors, except PS before stenting (P = 0.003), between the improved and non-improved groups. The P-value was 0.53 for the kinds of stents and prior radiation, and multiple logistic regression analysis was performed using the type of stents, prior radiation, and PS. The results are demonstrated in the table. Improvement in the dysphagia score was significantly associated with PS before stenting (adjusted odds ratio = 0.026, 95%CI 0.0019–0.37, P = 0.007). The area under the curve of the model (ln [odds of improvement of dysphagia score, Y = 1] = 1.9 − 3.1x; x = 1 [PS > 2], 0 [PS = 0–2]) was 0.82 (95%CI 0.65–0.99). PS was an independent factor for dysphagia improvement in patients with malignant esophageal strictures after stenting.Tabled 1statisticsUnadjusted OR (95%CI)P valueAdjusted OR (95% CI)P valuetype of stent3.6 (0.17-252)0.530.96 (0.046-20)0.98Radiation0.27 (0.0040-5.9)0.530.076 (0.002-2.8)0.16Pre-PS0.0054 (0.0031-0.52)0.0030.026 (0.0019-0.37)0.007 Open table in a new tab