Biliary stenting in advanced malignancy: an analysis of predictive factors for survival

Abstract

Purpose: Stenting of the biliary tree is a common palliative procedure to relieve obstructive jaundice in advanced malignancy. Although effective in relief of biliary obstruction and palliation of symptoms, little information is available on predictive factors for survival post-procedure. This retrospective study sought to assess factors influencing post-procedure survival in cancer patients after biliary stenting.

Methods: Case notes of all patients from a regional academic cancer center, who underwent biliary stenting for obstructive jaundice related to malignancy during 2008 and 2009 were reviewed. We collected epidemiological, biochemical, treatment and survival data on all patients. We used Kaplan-Meyer analysis to assess survival from day of first biliary stenting (adjusted for cancer types), and the Cox proportional hazards model for univariate and multivariate analysis.

Results: One hundred and ninety-four patients were included in the final analysis. Most cases were related to pancreatic cancer or cholangiocarcinoma (89 and 46 cases respectively). Median survival for all patients was 143 days. In multivariate analysis serum albumin ≥34 g/L at the time of procedure (hazard ratio 0.573; 95% confidence interval 0.424-0.773, P<0.001) and chemotherapy post-stent (hazard ratio 0.636; 95% confidence interval 0.455-0.889, P=0.008) were two independent prognostic factors predicting a better survival post-stenting. The 30 day mortality post-procedure in the 194 patients was 12%.

Conclusion: This study suggests that stenting of the biliary tree in cases of malignant obstruction allows durable palliation of symptoms even in cases where further active chemotherapy treatment is not possible. However, the better outcome observed in patients with albumin ≥34 g/L and those receiving chemotherapy post-stent requires further validation.

Keywords: biliary stent; cancer; jaundice; survival.

Figure 1

Frequency of cancer types treated. Abbreviations: PPC, primary peritoneal cancer; HCC, hepatocellular carcinoma.

Figure 2

Kaplan–Meier curve showing survival in days of all patients within the cohort in the final analysis. Note: The median survival was 143 days (95% confidence interval, 112–175). Abbreviation: Cum, cumulative.

Figure 3

Kaplan–Meier curve showing survival in days for patients who received chemotherapy post-stent and those who did not. Abbreviation: Cum, cumulative.

Figure 4

Kaplan–Meier curve showing survival in days for patients with low albumin levels (<34 g/L) in comparison to patients with normal albumin levels. Abbreviation: Cum, cumulative.