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Palliative stenting for oesophagogastric cancer: tumour and host factors and prognosis
  1. James Hugh Park1,2,
  2. Niall Woodley1,
  3. Donald C McMillan2 and
  4. Paul Glen1
  1. 1Department of Surgery, Queen Elizabeth University Hospital, Glasgow, UK
  2. 2Academic Unit of Surgery, School of Medicine, Dentistry and Nursing, College of Veterinary, Medical and Life Sciences, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr James Hugh Park, Department of Surgery, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK; james.park{at}glasgow.ac.uk

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.

  • gastrointestinal (upper)
  • dysphagia
  • systemic inflammation
  • self-expandable metallic stents
  • prognosis

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Footnotes

  • Contributors JHP was involved in the data collection and analysis, interpretation of data, writing and manuscript preparation. NW was responsible for the data collection and analysis. DCM and PG contributed to the study concept, data interpretation and manuscript writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval NHS Greater Glasgow and Clyde Clinical Governance and West of Scotland Upper Gastrointestinal Cancer Managed Clinical Network.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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