Percutaneous Transhepatic Biliary Stent Implantation for Obstructive Jaundice of Perihilar Cholangiocarcinoma: A Prospective Study on Predictors of Stent Patency and Survival in 92 Patients

• Published in: Journal of vascular and interventional radiology Vol. 27; no. 7; pp. 1047 - 1055.e2
• Main Authors: Li, Mingwu, MD, Li, Kai, MD, Qi, Xingshun, MD, Wu, Wenbin, MD, Zheng, Luanluan, MD, He, Chuangye, MD, Yin, Zhanxin, MD, Fan, Daiming, MD, Zhang, Zhuoli, MD, Han, Guohong, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2016
• Subjects: Adult; Aged; Aged, 80 and over; Ascites - etiology; Bile Duct Neoplasms - complications; Bile Duct Neoplasms - diagnostic imaging; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - pathology; CA-19-9 Antigen - blood; Cholestasis - diagnostic imaging; Cholestasis - etiology; Cholestasis - mortality; Cholestasis - therapy; Drainage - adverse effects; Drainage - instrumentation; Drainage - mortality; Female; Humans; Jaundice, Obstructive - diagnostic imaging; Jaundice, Obstructive - etiology; Jaundice, Obstructive - mortality; Jaundice, Obstructive - therapy; Kaplan-Meier Estimate; Klatskin Tumor - complications; Klatskin Tumor - diagnostic imaging; Klatskin Tumor - mortality; Klatskin Tumor - secondary; Lymphatic Metastasis; Male; Metals; Middle Aged; Multivariate Analysis; Neoplasm Staging; Palliative Care; Proportional Hazards Models; Prospective Studies; Prosthesis Design; Radiology; Risk Factors; Stents; Time Factors; Treatment Outcome; Tumor Burden; pCCA; American Joint Committee on Cancer; CI; ECOG; AJCC; cancer antigen 19-9; Eastern Cooperative Oncology Group; hazard ratio; perihilar cholangiocarcinoma; confidence interval; HR; CA19-9
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2016.02.035

Abstract Purpose To evaluate prognostic factors for stent patency and survival in patients with perihilar cholangiocarcinoma (pCCA) who underwent percutaneous biliary stent placement. Materials and Methods This prospective study followed 92 consecutive patients with pCCA who underwent metal stent placement between January 2013 and July 2014. Of the total number of patients, 11 had ascites, and 36 had biliary obstruction for > 1 month at the time of stent placement. Cumulative patency and survival rates were assessed with Kaplan-Meier curves, and independent predictors were calculated with Cox regression. A new formula was developed to predict patient survival. Results Tumor size was significantly associated with stent patency (hazard ratio = 2.425; 95% confidence interval, 1.134–5.168). Independent predictors of survival included lymph node metastasis, intrahepatic mass lesion, cancer antigen 19-9 (CA19-9), ascites, and duration of jaundice. A new equation was developed to assess risk: R = 7 × (duration of biliary obstruction—0 if < 30 d, 1 if > 30 d) + 7 × (CA19-9—0 if < 500, 1 if > 500) + 7 × (ascites—0 if none present, 1 if ascites present) + 10 × (lymph node metastasis—0 if no metastasis, 1 if metastasis present) + 9 (intrahepatic mass lesion—0 if absent, 1 if present). Among patients who developed stent occlusion, patients who underwent recanalization of the occluded stent had longer survival compared with patients who did not undergo recanalization (109 d vs 29 d, P = .001). Conclusions Prognostic factors for survival after percutaneous stent placement in patients with pCCA were tumor stage, duration of jaundice, CA19-9, and ascites. Tumor size affected stent patency. Prognosis for patients with reintervention after occlusion of the stent improved.