{"title":"内镜下胃十二指肠支架置入术治疗恶性胃出口梗阻后临床结果的预后影响:一项多中心回顾性队列研究，采用时间依赖性分析。","authors":"Yuji Hodo, Hajime Takatori, Takuya Komura, Yoshiro Asahina, Tomoyoshi Chiba, Hisashi Takabatake, Kenkei Hasatani, Ryuhei Nishino, Masaaki Yano, Yoshiko Takata, Tsuyoshi Suda, Haruhiko Shugo, Hiroyoshi Nakanishi, Kazutoshi Yamada, Kazuhiro Miwa, Kiichiro Kaji, Masaki Nishitani, Masaki Miyazawa, Taro Yamashita","doi":"10.1177/17562848231156279","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Endoscopic gastroduodenal stent (GDS) placement is widely used as a safe and effective method to rapidly improve gastrointestinal symptoms of malignant gastric outlet obstruction (MGOO). While previous studies reported the utility of chemotherapy after GDS placement for prognosis improvement, they did not fully address the issue of immortal time bias.</p><p><strong>Objectives: </strong>To examine the association between prognosis and clinical course following endoscopic GDS placement, using a time-dependent analysis.</p><p><strong>Design: </strong>Multicenter retrospective cohort study.</p><p><strong>Methods: </strong>This study included 216 MGOO patients who underwent GDS placement between April 2010 and August 2020. Data of patient baseline characteristics, including age, gender, cancer type, performance status (PS), GDS type and length, GDS placement location, gastric outlet obstruction scoring system (GOOSS) score, and history of chemotherapy before GDS were collected. The clinical course following GDS placement was evaluated by GOOSS score, stent dysfunction, cholangitis, and chemotherapy. A Cox proportional hazards model was used to identify prognostic factors after GDS placement. Stent dysfunction, post-stent cholangitis, and post-stent chemotherapy were analyzed as time-dependent covariates.</p><p><strong>Results: </strong>Mean GOOSS scores before and after GDS were 0.7 and 2.4, respectively, with significant improvement after GDS placement (<i>p</i> < 0.001). The median survival time after GDS placement was 79 [95% confidence interval (CI): 68-103] days. In multivariate Cox proportional hazards model with time-dependent covariates, PS 0-1 [hazard ratio (HR): 0.55, 95% CI: 0.40-0.75; <i>p</i> < 0.001], ascites (HR: 1.45, 95% CI: 1.04-2.01; <i>p</i> = 0.028), metastasis (HR: 1.84, 95% CI: 1.31-2.58; <i>p</i> < 0.001), post-stent cholangitis (HR: 2.38, 95% CI: 1.37-4.15; <i>p</i> = 0.002), and post-stent chemotherapy (HR: 0.01, 95% CI: 0.002-0.10; <i>p</i> < 0.001) significantly affected prognosis after GDS placement.</p><p><strong>Conclusion: </strong>Post-stent cholangitis and tolerability to receive chemotherapy after GDS placement influenced prognosis in MGOO patients.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231156279"},"PeriodicalIF":4.2000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/e4/10.1177_17562848231156279.PMC9989375.pdf","citationCount":"0","resultStr":"{\"title\":\"Prognostic impact of clinical outcome after endoscopic gastroduodenal stent placement for malignant gastric outlet obstruction: a multicenter retrospective cohort study using a time-dependent analysis.\",\"authors\":\"Yuji Hodo, Hajime Takatori, Takuya Komura, Yoshiro Asahina, Tomoyoshi Chiba, Hisashi Takabatake, Kenkei Hasatani, Ryuhei Nishino, Masaaki Yano, Yoshiko Takata, Tsuyoshi Suda, Haruhiko Shugo, Hiroyoshi Nakanishi, Kazutoshi Yamada, Kazuhiro Miwa, Kiichiro Kaji, Masaki Nishitani, Masaki Miyazawa, Taro Yamashita\",\"doi\":\"10.1177/17562848231156279\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Endoscopic gastroduodenal stent (GDS) placement is widely used as a safe and effective method to rapidly improve gastrointestinal symptoms of malignant gastric outlet obstruction (MGOO). While previous studies reported the utility of chemotherapy after GDS placement for prognosis improvement, they did not fully address the issue of immortal time bias.</p><p><strong>Objectives: </strong>To examine the association between prognosis and clinical course following endoscopic GDS placement, using a time-dependent analysis.</p><p><strong>Design: </strong>Multicenter retrospective cohort study.</p><p><strong>Methods: </strong>This study included 216 MGOO patients who underwent GDS placement between April 2010 and August 2020. Data of patient baseline characteristics, including age, gender, cancer type, performance status (PS), GDS type and length, GDS placement location, gastric outlet obstruction scoring system (GOOSS) score, and history of chemotherapy before GDS were collected. The clinical course following GDS placement was evaluated by GOOSS score, stent dysfunction, cholangitis, and chemotherapy. A Cox proportional hazards model was used to identify prognostic factors after GDS placement. Stent dysfunction, post-stent cholangitis, and post-stent chemotherapy were analyzed as time-dependent covariates.</p><p><strong>Results: </strong>Mean GOOSS scores before and after GDS were 0.7 and 2.4, respectively, with significant improvement after GDS placement (<i>p</i> < 0.001). The median survival time after GDS placement was 79 [95% confidence interval (CI): 68-103] days. In multivariate Cox proportional hazards model with time-dependent covariates, PS 0-1 [hazard ratio (HR): 0.55, 95% CI: 0.40-0.75; <i>p</i> < 0.001], ascites (HR: 1.45, 95% CI: 1.04-2.01; <i>p</i> = 0.028), metastasis (HR: 1.84, 95% CI: 1.31-2.58; <i>p</i> < 0.001), post-stent cholangitis (HR: 2.38, 95% CI: 1.37-4.15; <i>p</i> = 0.002), and post-stent chemotherapy (HR: 0.01, 95% CI: 0.002-0.10; <i>p</i> < 0.001) significantly affected prognosis after GDS placement.</p><p><strong>Conclusion: </strong>Post-stent cholangitis and tolerability to receive chemotherapy after GDS placement influenced prognosis in MGOO patients.</p>\",\"PeriodicalId\":23022,\"journal\":{\"name\":\"Therapeutic Advances in Gastroenterology\",\"volume\":\"16 \",\"pages\":\"17562848231156279\"},\"PeriodicalIF\":4.2000,\"publicationDate\":\"2023-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/e4/10.1177_17562848231156279.PMC9989375.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Therapeutic Advances in Gastroenterology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/17562848231156279\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17562848231156279","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:内镜下胃十二指肠支架置入术(GDS)作为一种安全有效的快速改善恶性胃出口梗阻(MGOO)胃肠道症状的方法被广泛应用。虽然以前的研究报道了GDS放置后化疗对预后改善的效用，但它们并没有完全解决不朽时间偏差的问题。目的:通过时间相关分析，研究内镜下GDS放置后的预后与临床病程之间的关系。设计:多中心回顾性队列研究。方法:本研究纳入了2010年4月至2020年8月期间接受GDS安置的216例MGOO患者。收集患者基线特征资料，包括年龄、性别、肿瘤类型、表现状态(performance status, PS)、GDS类型及长度、GDS放置位置、胃出口梗阻评分系统(GOOSS)评分、GDS前化疗史等。通过GOOSS评分、支架功能障碍、胆管炎和化疗来评估GDS放置后的临床过程。采用Cox比例风险模型确定GDS植入后的预后因素。支架功能障碍、支架后胆管炎和支架后化疗作为时间相关协变量进行分析。结果:GDS前后平均GOOSS评分分别为0.7分和2.4分，放置GDS后显著改善(p p p = 0.028)，转移(HR: 1.84, 95% CI: 1.31-2.58;p p = 0.002)，支架后化疗(HR: 0.01, 95% CI: 0.002-0.10;结论:GDS置入后胆管炎及化疗耐受性影响MGOO患者的预后。
Prognostic impact of clinical outcome after endoscopic gastroduodenal stent placement for malignant gastric outlet obstruction: a multicenter retrospective cohort study using a time-dependent analysis.
Background: Endoscopic gastroduodenal stent (GDS) placement is widely used as a safe and effective method to rapidly improve gastrointestinal symptoms of malignant gastric outlet obstruction (MGOO). While previous studies reported the utility of chemotherapy after GDS placement for prognosis improvement, they did not fully address the issue of immortal time bias.
Objectives: To examine the association between prognosis and clinical course following endoscopic GDS placement, using a time-dependent analysis.
Design: Multicenter retrospective cohort study.
Methods: This study included 216 MGOO patients who underwent GDS placement between April 2010 and August 2020. Data of patient baseline characteristics, including age, gender, cancer type, performance status (PS), GDS type and length, GDS placement location, gastric outlet obstruction scoring system (GOOSS) score, and history of chemotherapy before GDS were collected. The clinical course following GDS placement was evaluated by GOOSS score, stent dysfunction, cholangitis, and chemotherapy. A Cox proportional hazards model was used to identify prognostic factors after GDS placement. Stent dysfunction, post-stent cholangitis, and post-stent chemotherapy were analyzed as time-dependent covariates.
Results: Mean GOOSS scores before and after GDS were 0.7 and 2.4, respectively, with significant improvement after GDS placement (p < 0.001). The median survival time after GDS placement was 79 [95% confidence interval (CI): 68-103] days. In multivariate Cox proportional hazards model with time-dependent covariates, PS 0-1 [hazard ratio (HR): 0.55, 95% CI: 0.40-0.75; p < 0.001], ascites (HR: 1.45, 95% CI: 1.04-2.01; p = 0.028), metastasis (HR: 1.84, 95% CI: 1.31-2.58; p < 0.001), post-stent cholangitis (HR: 2.38, 95% CI: 1.37-4.15; p = 0.002), and post-stent chemotherapy (HR: 0.01, 95% CI: 0.002-0.10; p < 0.001) significantly affected prognosis after GDS placement.
Conclusion: Post-stent cholangitis and tolerability to receive chemotherapy after GDS placement influenced prognosis in MGOO patients.
期刊介绍：
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
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