Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2016; 22(26): 6065-6075
Published online Jul 14, 2016. doi: 10.3748/wjg.v22.i26.6065
Impact of biliary stent-related events in patients diagnosed with advanced pancreatobiliary tumours receiving palliative chemotherapy
Angela Lamarca, Christina Rigby, Mairéad G McNamara, Richard A Hubner, Juan W Valle
Angela Lamarca, Christina Rigby, Mairéad G McNamara, Richard A Hubner, Juan W Valle, Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, Manchester, United Kingdom
Mairéad G McNamara, Juan W Valle, Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, Manchester, United Kingdom
Author contributions: Lamarca A and Valle JW designed the research; Lamarca A and Rigby C collected the data; Lamarca A performed data analysis; Lamarca A, Rigby C, McNamara MG, Hubner RA and Valle JW were involved in result interpretation and approved the final version of this manuscript.
Supported by Pancreatic Cancer Research Fund and Spanish society of Medical Oncology (Lamarca A).
Institutional review board statement: The study was reviewed and approved by The Christie NHS Foundation Trust (Manchester, United Kingdom); institutional approval number CE15/1400.
Informed consent statement: Not applicable to this study.
Conflict-of-interest statement: Authors declare no conflict-of-interest related to this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Juan W Valle, Professor, Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, Manchester, United Kingdom. juan.valle@manchester.ac.uk
Telephone: +44-161-4468106 Fax: +44-161-4463468
Received: December 24, 2015
Peer-review started: December 24, 2015
First decision: January 28, 2016
Revised: February 2, 2016
Accepted: March 1, 2016
Article in press: March 2, 2016
Published online: July 14, 2016
Abstract

AIM: To determine the impact (morbidity/mortality) of biliary stent-related events (SRE) (cholangitis or stent obstruction) in chemotherapy-treated pancreatico-biliary patients.

METHODS: All consecutive patients with advanced pancreatobiliary cancer and a biliary stent in-situ prior to starting palliative chemotherapy were identified retrospectively from local electronic case-note records (Jan 13 to Jan 15). The primary end-point was SRE rate and the time-to-SRE (defined as time from first stenting before chemotherapy to date of SRE). Progression-free survival and overall survival were measured from the time of starting chemotherapy. Kaplan-Meier, Cox and Fine-Gray regression (univariate and multivariable) analyses were employed, as appropriate. For the analysis of time-to-SRE, death was considered as a competing event.

RESULTS: Ninety-six out of 693 screened patients were eligible; 89% had a metal stent (the remainder were plastic). The median time of follow-up was 9.6 mo (range 2.2 to 26.4). Forty-one patients (43%) developed a SRE during follow-up [cholangitis (39%), stent obstruction (29%), both (32%)]. There were no significant differences in baseline characteristics between the SRE group and no-SRE groups. Recorded SRE-consequences were: none (37%), chemotherapy delay (24%), discontinuation (17%) and death (22%). The median time-to-SRE was 4.4 mo (95%CI: 3.6-5.5). Patients with severe comorbidities (P < 0.001) and patients with ≥ 2 baseline stents/biliary procedures [HR = 2.3 (95%CI: 1.2-4.44), P = 0.010] had a shorter time-to-SRE on multivariable analysis. Stage was an independent prognostic factor for overall survival (P = 0.029) in the multivariable analysis adjusted for primary tumour site, performance status and development of SRE (SRE group vs no-SRE group).

CONCLUSION: SREs are common and impact on patient’s morbidity. Our results highlight the need for prospective studies exploring the role of prophylactic strategies to prevent/delay SREs.

Keywords: Advanced biliary tract cancer, Pancreatic cancer, Biliary obstruction, Biliary stent, Stent-related event

Core tip: Most patients diagnosed with advanced malignancies of the pancreas or bile ducts present with biliary obstruction; this requires biliary stenting before starting treatment with palliative chemotherapy. The impact of developing stent-related events (SRE) such as cholangitis or stent obstruction (and the potential role of prophylactic treatment in order to reduce the risk of developing SREs) has not been explored in this patient population. Our results have identified that SREs are common and adversely impact on patient’s morbidity (and possibly mortality) and support the need for prospective studies investigating the role of prophylaxis in this population.