title: Timely airway stenting improves survival in patients with malignant central airway obstruction.
abstract: BACKGROUND
  The survival of patients with malignant central airway obstruction is very limited. Although airway stenting results in significant palliation of symptoms, data regarding improved survival after stenting for advanced thoracic cancer with central airway obstruction are lacking.
  
  
  METHODS
  Fifty patients received a total of 72 airway stents for malignant central airway obstruction over a two-year period at a single institution. The Medical Research Council (MRC) dyspnea scale and Eastern Cooperative Oncology Group (ECOG) performance status were used to divide patients into a poor performance group (MRC = 5, ECOG = 4) and an intermediate performance group (MRC ≤ 4, ECOG ≤ 3). The SPSS version 16.0 (SPSS Inc, Chicago, IL) and Microsoft Excel (Microsoft, Redmond, WA) were used to analyze the data. Survival curves were constructed using the Kaplan-Meier survival analysis method and a log-rank test was used to compare the survival distributions among different groups.
  
  
  RESULTS
  Successful patency of the airway was achieved in all patients with no procedure-related mortality. Stenting resulted in significant improvement in MRC and ECOG performance scores (p < 0.01). Significantly improved survival was observed only in patients in the intermediate performance group compared with patients in the poor performance group (p < 0.05).
  
  
  CONCLUSIONS
  Airway stenting resulted in significant palliation of symptoms in both groups as evaluated by MRC dyspnea scale and ECOG performance status. Compared with historic controls, a significant survival advantage was seen only in the intermediate performance group. We postulate that timely stenting of the airway, before the morbid complications of malignant central airway obstruction have set in, results in improved survival.
authors.affiliation: Division of Thoracic Surgery, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Syed S
authors.initials: SS
authors.lastname: Razi
authors.forename: Robert S
authors.initials: RS
authors.lastname: Lebovics
authors.forename: Gary
authors.initials: G
authors.lastname: Schwartz
authors.forename: Manu
authors.initials: M
authors.lastname: Sancheti
authors.forename: Scott
authors.initials: S
authors.lastname: Belsley
authors.forename: Cliff P
authors.initials: CP
authors.lastname: Connery
authors.forename: Faiz Y
authors.initials: FY
authors.lastname: Bhora
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome