Survival outcome of airway stenting in patients with esophageal cancer with airway involvement.

Abstract

Background: Airway stenting in patients with esophageal cancer involving the airway possibly improves survival by relieving the symptoms of obstructive pneumonitis and facilitating cancer treatment. However, its advantages over conservative management remain unclear. Therefore, we compared the survival outcomes of airway stenting and conservative treatment in patients with advanced esophageal cancer.

Methods: We retrospectively reviewed patients with advanced esophageal cancer involving the airway who were treated at Taipei Veterans General Hospital between July 2005 and January 2023. Airway involvement included airway obstruction with obstructive symptoms or esophago-respiratory fistulas. Patients were categorized into the stent and conservative treatment groups. We compared patients' clinical characteristics, post-airway involvement survival (PAIS), and overall survival (OS) and assessed the prognostic factors for survival.

Results: A total of 52 patients, including 31 with airway stenting and 21 with conservative treatment, were included. No differences were observed between the two treatment groups in terms of age, sex, body mass index, clinical performance (Eastern Cooperative Oncology Group [ECOG]), tumor location, clinical N stage, or site of airway involvement. However, the conservative treatment group had more patients with clinical T4 stage ( p < 0.001) and M1 stage ( p = 0.04) than did the stent group. PAIS (117 vs 43 days; p = 0.02) and OS (351 vs 106 days; p < 0.001) were significantly longer in the stent group than in the conservative treatment group. In addition, airway stenting significantly reduced pneumonia-related mortality (9.7% vs 52.4%; p = 0.001). Multivariable analysis revealed anticancer treatment after airway involvement (hazard ratio [HR], 0.13; confidence interval [CI], 0.06-0.27; p < 0.001) and airway stenting (HR, 0.37; CI, 0.20-0.68; p = 0.001) as significant prognostic factors for PAIS. For OS, ECOG ≥1 (HR, 2.20; CI, 1.09-4.42; p = 0.03) and airway stenting (HR, 0.37; CI, 0.17-0.78; p = 0.01) were significant prognostic factors.

Conclusion: Airway stenting reduced pneumonia-related mortality in patients with advanced esophageal cancer with airway involvement. Moreover, patients who underwent airway stenting had better survival than did those who received conservative treatment alone; thus, airway stenting should be recommended after careful patient selection.