Original article
General thoracic
Prognostic Factors Associated With Interventional Bronchoscopy in Lung Cancer

https://doi.org/10.1016/j.athoracsur.2013.07.118Get rights and content

Background

Interventional bronchoscopy is an effective procedure for malignant central airway obstruction, although its indications are poorly defined and its benefits difficult to predict. The purpose of the study was to identify the patients' or the disease's characteristics that are correlated with survival to enable clinicians to identify the best indications.

Methods

We retrospectively studied the data from 204 patients treated between 2004 and 2010. We analyzed survival times according to the patients' or disease's characteristics, and identified homogeneous risks using classification and regression trees.

Results

Reduced survival was associated with a high American Society of Anesthesiologists score (13, 5.9, and 2.9 months for scores of 2, 3, and 4, respectively; p = 0.0005), nonsquamous cell histology (median survival, 6.3 months; p = 0.007), metastatic tumors (9.2 and 6.2 months for stage IIIA and IIIB, respectively, versus 3 months for stage IV; p = 0.0002), and for patients who had not received a specific treatment (median survival, 8.6 versus 3.2 months for untreated patients; p < 0.0001). Classification and regression trees segmentation identified five distinct groups of patients. Patients receiving a specific treatment for squamous cell carcinoma derived the best survival (median, 13 months; p < 0.0001), whereas patients with an American Society of Anesthesiologists score of 4 treated for large cell cancer or adenocarcinoma and metastatic patients who did not receive any specific treatment had the worst survival (0.8 months and 2.7 months, respectively; p < 0.0001).

Conclusions

Interventional bronchoscopy is a safe and effective procedure that should be integrated into a multimodal therapy for selected patients.

Section snippets

Patients

We included all patients treated at our center, between January 2004 and January 2011, for central airway obstruction caused by lung cancer. Exclusion criteria were endobronchial metastasis, tracheoesophageal fistula from esophageal cancer, and tumors with uncertain malignancies.

We collected data on age, sex, body mass index, and American Society of Anesthesiologists (ASA) score, plus details of preoperative radiography (atelectasis, pneumonia) from each patient. The characteristics of the

Population

The study included 204 patients, of which 153 were men (74.8%). The average age was 64.4 years. The characteristics of the patients and types of cancer are reported in Table 1.

The ASA score was 3 or 4 for 79.7% of patients, and ASA 2 for only 20.3%. Squamous cell carcinoma strongly predominated over other histologic types, followed by adenocarcinoma (19.6%). Patients were treated for locally advanced (stage IIIA or IIIB in 61%) or metastatic disease (39%). The sites of the lesions are described

Comment

Intervention was considered effective (according to endoscopic criteria) in the vast majority of cases, as has been reported by other teams 15, 18. A complication was noted in 10.3% of our cases. The mortality rate in the first 48 hours was only 1.9%. Of these 4 patients, 3 were ASA score 4, 3 had metastatic cancer, and 3 had been treated for acute respiratory distress. We observed more complications than when a single thermal method was used 7, 19, but our rate of complications is similar to

References (32)

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