title: Stent patency using competing risk model in unresectable pancreatic cancers inserted with biliary self-expandable metallic stent.
abstract: OBJECTIVE
  Biliary self-expandable metallic stents (SEMS) play an important role in the quality of life and palliative treatment in unresectable pancreatic cancer patients. We aimed to determine the factors affecting the patency of biliary SEMS and the survival in unresectable pancreatic cancer with obstructive jaundice.
  
  
  METHODS
  Considering the competing risk and survival, we retrospectively evaluated the patency in 107 unresectable pancreatic cancer patients with obstructive jaundice who were successfully treated with biliary SEMS from January 2000 to April 2010.
  
  
  RESULTS
  There were 107 incidents of biliary drainage that were clinically successful and the overall survival period was a median of 133 days. Stent occlusion before death was observed in 36 (33.6%) of 107 patients. Cumulative stent obstruction rates were 4.7%, 16.8%, and 24.4% at 1, 3, and 6 months, respectively. Lower cancer stage (<5 month's hazard ratio [HR] = 2.327, >5 month's HR = 0.108) was only associated with the longer patency of the stents in a multivariable analysis using a Fine and Gray model that considered competing risk. In multivariable analysis, lower cancer stage, uncovered stent and normalized serum bilirubin level were associated with a longer survival period (HR = 2.335, 1.906 and 1.795 respectively, P < 0.05).
  
  
  CONCLUSIONS
  The patency of biliary SEMS in unresectable pancreatic cancers might be affected by the stage. Lower cancer stage and normalized bilirubin are associated with longer survival.
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Young Ook
authors.initials: YO
authors.lastname: Eum
authors.forename: Yong-Tae
authors.initials: YT
authors.lastname: Kim
authors.forename: Sang Hyub
authors.initials: SH
authors.lastname: Lee
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Jin-Hyeok
authors.initials: JH
authors.lastname: Hwang
authors.forename: Won Jae
authors.initials: WJ
authors.lastname: Yoon
authors.forename: Ji Kon
authors.initials: JK
authors.lastname: Ryu
authors.forename: Yong Bum
authors.initials: YB
authors.lastname: Yoon
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.forename: Chang Jin
authors.initials: CJ
authors.lastname: Yoon
authors.forename: Jung-Hwa
authors.initials: JH
authors.lastname: Cho
authors.forename: Yunhee
authors.initials: Y
authors.lastname: Choi
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000628:therapy*; D008297:Male; D008670:Metals; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications / Q000628:therapy*; D016016:Proportional Hazards Models; D011788:Quality of Life; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D008670:Metals