title: Which patients with advanced cancer and biliary obstruction benefit from biliary stenting most? An analysis of prognostic factors.
abstract: BACKGROUND
  Patients with advanced cancer may present with obstructive jaundice. Biliary stenting is the treatment of choice. However, which patients benefit most is not well-defined, yet. Our aim was to delineate the clinical factors affecting prognosis.
  
  
  METHODS
  Charts of 140 patients with advanced cancer who underwent biliary stenting were retrospectively analyzed. Their median age was 63.5 years. Of these patients, 73 (52.1 %) were male, 32 (22.9 %) had ECOG PS 1 and 81 (57.9 %) had PS 2. The most frequent cancer types were cholangiocellular cancer (64, 45.7 %) and pancreatic cancer (36, 25.7 %).
  
  
  RESULTS
  Median overall survival (OS) was 141 (95 % CI, 100.7-185.3) days. Female patients lived longer (161.0 vs. 124.0 days) (p = 0.036). Those patients with colorectal cancer lived the longest (667.0 days), followed by cholangiocellular (211.0 days), and gastric cancers (106.0 days) (p = 0.004). The distribution of primary diagnosis differed significantly between sexes: cholangiocellular cancer was present in 22 (30.1 %) out of 73 men and 42(62.7 %) out of 67 women (chi-square p < 0.001). There was a trend for longer overall survival if ALT (p = 0.08) and AST (p = 0.06) were normalized after stent insertion. Of the 137 patients, 63 (45.5 %) did not experience any complication. In 74 patients with complications, there were 39 (28.5 %) episodes of cholangitic infections and 35 (25.5 %) biliary obstructions. In three patients, we could not find data on infections.
  
  
  CONCLUSIONS
  Underlying malignancy, hence the natural biology and the therapeutic expectations are probably the most important factors which must be considered during decision-making.
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology, Başkent University School of Medicine, Adana, Turkey. habali1970@yahoo.com
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Abali
authors.forename: Ahmet
authors.initials: A
authors.lastname: Sezer
authors.forename: Levent
authors.initials: L
authors.lastname: Oğuzkurt
authors.forename: Kamil
authors.initials: K
authors.lastname: Gürel
authors.forename: Uğur
authors.initials: U
authors.lastname: Özkan
authors.forename: Ali Ayberk
authors.initials: AA
authors.lastname: Beşen
authors.forename: Ahmet Taner
authors.initials: AT
authors.lastname: Sümbül
authors.forename: Fatih
authors.initials: F
authors.lastname: Köse
authors.forename: Umut
authors.initials: U
authors.lastname: Dişel
authors.forename: Sadık
authors.initials: S
authors.lastname: Muallaoğlu
authors.forename: Özgür
authors.initials: Ö
authors.lastname: Özyılkan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000601:surgery*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000473:pathology; D017063:Outcome Assessment, Health Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis