Palliative stenting for oesophagogastric cancer: tumour and host factors and prognosis

Park, J. H. , Woodley, N., McMillan, D. C. and Glen, P. (2019) Palliative stenting for oesophagogastric cancer: tumour and host factors and prognosis. BMJ Supportive and Palliative Care, 9, pp. 332-339. (doi: 10.1136/bmjspcare-2017-001490) (PMID:29574423)

Abstract

Objectives: Palliative self-expandable metallic stent (SEMS) insertion is common in patients not suitable for resection of oesophagogastric (OG) cancer. Factors which may determine survival, however, are not clear. The present study examined the relationship between tumour and host factors, including the systemic inflammatory response and survival of patients undergoing palliative SEMS insertion. Methods: Patients with a diagnosis of OG cancer who were considered suitable for palliative SEMS only without systemic therapy were identified. Patient characteristics including Eastern Cooperative Oncology Group performance status, radiological stage and modified Glasgow Prognostic Score (mGPS: 0—C-reactive protein (CRP) ≤10 mg/L; 1—CRP >10 mg/L; 2—CRP >10 mg/L; albumin <35 g/L) were recorded prospectively. The relationship between such characteristics and 3-month survival was examined. Results: 203 patients were included in the final analysis. All patients died during follow-up, with median survival from diagnosis 75 days (IQR 47–157). 78% of patients were systemically inflamed (mGPS >1). On multivariate analysis, only poor performance status (HR 1.23, p=0.025), metastatic disease (HR 2.27, p<0.001) and mGPS (HR 1.25, p=0.021) were associated with shorter survival. The combination of performance status and mGPS stratified 3-month survival of patients without metastatic disease from 88% to 20% (p<0.001) and patients with metastases from 43% to 6% (p=0.059). Similar results were observed when analysis was restricted to patients with oesophageal and junctional cancer (M0: 83%–20%, p=0.008; M1: 33%–8%, p=0.082). Conclusion: Performance status, metastatic disease and mGPS are independent predictors of survival in patients with OG cancer undergoing palliative SEMS insertion. These routinely available markers provide a rational system on which to base decisions regarding prognosis and treatment.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Park, Mr James and Glen, Mr Paul and McMillan, Professor Donald
• Authors: Park, J. H., Woodley, N., McMillan, D. C., and Glen, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: BMJ Supportive and Palliative Care
• Publisher: BMJ Publishing Group
• ISSN: 2045-435X
• ISSN (Online): 2045-4368
• Published Online: 23 March 2018
• Copyright Holders: Copyright © 2018 The Authors
• First Published: First published in BMJ Supportive and Palliative Care 9:332-339
• Publisher Policy: Reproduced in accordance with the publisher copyright policy