Predictive factors for survival of patients with inoperable malignant distal biliary strictures: a practical management guideline

• Published in: Gut Vol. 42; no. 1; pp. 76 - 80
• Main Authors: Prat, F, Chapat, O, Ducot, B, Ponchon, T, Fritsch, J, Choury, A D, Pelletier, G, Buffet, C
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.01.1998; BMJ; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Aged, 80 and over; Bile; Bile Duct Neoplasms - complications; Bile Ducts, Intrahepatic; Biliary and Pancreatic Disease; biliary tract cancer; Biological and medical sciences; Biopsy; Cholangiocarcinoma - complications; Common Bile Duct Diseases - mortality; Common Bile Duct Diseases - pathology; Common Bile Duct Diseases - surgery; Constriction, Pathologic - surgery; Cost-Benefit Analysis; Diseases of the digestive system; endoscopic retrograde cholangiopancreatography; Endoscopy; Female; Histology; Humans; Male; Medical prognosis; Medical sciences; Metastasis; Middle Aged; Morphology; Multivariate Analysis; Palliative Care; palliative treatment; pancreatic cancer; Pancreatic Neoplasms - complications; Prognosis; prognostic factors; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Stents; Studies; Surgery; Survival Rate; Tomography; Tumors; Ultrasonic imaging; Weight Loss; Human; Cholangiopancreatography; Evaluation; Costs; Carcinoma; Radiodiagnosis; Retrograde; Instrumental dilatation; Palliative treatment; Malignant tumor; Biliary tract disease; Stent; Retrospective; Unresectable; Digestive diseases; Predictive factor; Pancreas; Main biliary tract; Comparative study; Pancreatic disease
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.42.1.76

Background—Stenting is the treatment of choice for inoperable malignant strictures of the common bile duct. Criteria for the choice of stents (plastic versus metallic) remain controversial because predicting survival is difficult. Aims—To define prognostic factors in order to improve the cost effectiveness of endoscopic palliation. Patients—One hundred and one patients were included in a prospective trial. Seven prognostic variables for survival were analysed (age, sex, bilirubinaemia, weight loss, presence of liver metastases, and tumour histology and size). All patients were followed until death or at least one year after inclusion. By the end of the study, 81 (80.2%) patients had died. Results—In univariate analysis, the variables associated with survival were weight loss (p<0.05) and tumour size (p<0.01). By multivariate analysis, tumour size was the only independent prognostic factor (p<0.05). A threshold of 30 mm at diagnosis distinguished two survival profiles: the median survival of patients with a tumour greater than 30 mm was 3.2 months, whereas it was 6.6 months for patients with a tumour less than 30 mm (p<0.001). Conclusions—A practical strategy could be based on tumour size at diagnosis: a metal stent should be systematically chosen for patients with an inoperable tumour smaller than 30 mm, while larger tumours are efficiently palliated by a plastic stent.