Risk factors for covered metallic stent migration in patients with distal malignant biliary obstruction due to pancreatic cancer
Risk factors for covered metallic stent migration in patients with distal malignant biliary obstruction due to pancreatic cancer
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DOI：
10.1111/jgh.12602
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发表时间：
2014-09-01
影响因子：
4.1
通讯作者：
Koike, Kazuhiko
中科院分区：
文献类型：
--
作者：
Nakai, Yousuke;Isayama, Hiroyuki;Koike, Kazuhiko
背景和目的：覆盖金属支架（CMS）的开发是为了克服恶性胆道梗阻的未覆盖金属支架（UMS）中的肿瘤向内生长，但由于 CMS 的高迁移率，CMS 相对于 UMS 的优越性仍然存在争议。因此，我们进行了回顾性分析，以明确支架移位的危险因素，包括 CMS 的机械特性。方法：对在五个三级医疗中心因远端恶性胆道梗阻而接受 CMS 的不可切除胰腺癌患者进行回顾性研究。使用比例风险模型进行单变量和多变量分析，以确定早期（< 6 个月）支架移位的预后因素，其中死亡或支架闭塞而无支架移位作为竞争风险。分析中包括两个机械特性：轴向力（导致 CMS 伸直的恢复力）和径向力 (RF)（对抗狭窄的扩张力）。 结果：在 290 名因远端恶性胆道梗阻接受 CMS 放置的患者中，支架迁移率为 15.2%。 CMS 提前迁移（< 6 个月）的比例分别为 10.0% 和远端迁移的比例分别为 11.7%。在多变量分析中，早期支架迁移的显着危险因素是化疗（亚分布风险比[SHR] 4.46，P = 0.01）、低RF CMS（SHR 2.23，P = 0.03）和十二指肠侵犯（SHR 2.25，P = 0.02）。结论：低RF CMS、化疗和十二指肠侵犯与我们研究中的CMS 迁移相关。
Background and Aim: Covered metallic stents (CMSs) were developed to overcome tumor ingrowth in uncovered metallic stents (UMSs) for malignant biliary obstruction, but superiority of CMSs over UMSs is still controversial due to the high migration rate in CMS. Therefore, we conducted this retrospective analysis to clarify risk factors for stent migration, including mechanical properties of CMSs.Methods: Patients with unresectable pancreatic cancer, receiving CMS for distal malignant biliary obstruction in five tertiary care centers, were retrospectively studied. Univariate and multivariate analyses to identify prognostic factors for early (< 6 months) stent migration were performed using a proportional hazards model with death or stent occlusion without stent migration as a competing risk. Two mechanical properties were included in the analysis: axial force, the recovery force that leads to a CMS straightening, and radial force (RF), the expansion force against the stricture.Results: Among 290 patients who received CMS placement for distal malignant biliary obstruction, stent migration rate was 15.2%. CMS migrated early (< 6 months) in 10.0% and distally in 11.7%, respectively. In the multivariate analysis, significant risk factors for early stent migration were chemotherapy (subdistribution hazard ratios [SHR] 4.46, P = 0.01), CMS with low RF (SHR 2.23, P = 0.03), and duodenal invasion (SHR 2.25, P = 0.02).Conclusion: CMS with low RF, chemotherapy, and duodenal invasion were associated with CMS migration from our study.