ABSTRACT
OBJECTIVES: In patients with unresectable pancreatic cancer, estimation of individual prognosis is essential to provide the most suitable biliary stent (self-expanding metal stent or plastic stent). The aim of the current study was to determine prognostic factors for survival in patients with unresectable pancreatic cancer after initial biliary drainage. PATIENTS AND METHODS: The current study included 278 patients with unresectable pancreatic cancer. Prognostic factors for survival were analyzed using the Cox proportional hazards model, the Kaplan-Meier survival estimator, and the Wilcoxon test for difference in survival. RESULTS: In univariate analysis, advanced T stage according to the TNM classification (P = 0.021, Wald test) and the presence of distant metastases (P = 0.001, Wald test) were predictive factors for shorter survival. However, in multivariate analysis, the presence of distant metastasis was the only independent prognostic factor. The median survival time after initial biliary drainage was 3.1 and 6.6 months in patients with and without the presence of distant metastases, respectively. CONCLUSIONS: The presence of distant metastases was identified as the only independent prognostic factor for survival after initial biliary drainage. A self-expanding metal stent should be systematically chosen for patient without distant metastases, whereas polyethylene plastic stents should be preferred in patients with distant metastases.
Subject(s)
Drainage/methods , Pancreatic Neoplasms/therapy , Adult , Aged , Aged, 80 and over , Drug Therapy/methods , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Multivariate Analysis , Neoplasm Staging , Outcome Assessment, Health Care/statistics & numerical data , Palliative Care/methods , Pancreatic Neoplasms/pathology , Prognosis , Proportional Hazards Models , Radiotherapy/methods , Stents , Time FactorsABSTRACT
OBJECTIVES: Endoscopic biliary drainage is widely accepted as palliative treatment in patients with pancreatic cancer. The current study was designed to compare self-expanding metal stent and polyethylene stent in a homogeneous patient group with advanced pancreatic cancer. METHODS: The study included 154 patients initially treated with a metal or plastic stent. Median survival time, stent patency, and stent-associated hospital admissions were evaluated. RESULTS: The median survival time in patients treated with metal and plastic stent was 5.9 and 4.4 months (P = 0.074), respectively. Self-expanding metal stents have a significantly higher patency rate than polyethylene stents. Stent occlusion was observed in 21 (33%) of 63 patients in the plastic stent group after a median period of 57 days and in 17 (19%) of 91 patients in the metal stent group after a median period of 126 days. The total time of hospital stay after initial implantation of metal or plastic stent was 7 and 16.5 days, respectively (P < 0.001). CONCLUSIONS: Self-expanding metal stents have a longer patency than polyethylene stents. Additionally, the number of stent-associated hospital admissions and the total time of hospital stay were higher in the plastic stent group. The median survival time was not significantly different in both groups.
