title: Percutaneous transhepatic biliary drainage in patients with advanced solid malignancies: prognostic factors and clinical outcomes.
abstract: OBJECTIVE
  Obstructive jaundice (OJ) is a cumbersome complication in late-stage malignancies, and percutaneous transhepatic biliary drainage (PTBD) is often used to relieve symptoms and allow chemotherapy (CT).
  
  
  METHODS
  From July 2008 to August 2011, 71 patients (pts) with OJ due to solid malignancies underwent PTBD in our institution. Baseline characteristics, procedure complications, and outcomes were retrospectively collected. The primary objective was to estimate overall survival (OS) after PTBD.
  
  
  RESULTS
  Median age was 60 years, 63% had an ECOG performance status (PS) of 1-2, and 10% were receiving supportive care (SC). Most had primary gastrointestinal tumors (89%) and metastatic disease at diagnosis (59%). Mean hospital stay was 16.6 days (2-90 days), with bilirubin value decreased (BVD) after 80% of procedures. Cholangitis was observed in 66.2% of pts and 60.6% required readmissions. Only 51.6% of pts not in SC were eligible for CT after PTBD. Median OS was 2.9 months (95% CI 0.62-5.2). Prognostic factors on univariate analysis include ECOG ≤2 (6.8 versus 0.79 months, p < 0.0001), BVD (6.7 versus 0.33 months, p < 0.0001), and CT after PTBD (13.7 versus 1.2 months p < 0.0001). On multivariate analysis, CT after procedure was related to better OS (HR 0.15, CI 0.06-0.38, p < 0.001).
  
  
  CONCLUSIONS
  Malignant OJ is a late event in cancer pts. Thorough evaluation is needed before determining eligibility to PTBD due to its high complication and hospitalization rates. In the current analysis, pts with PS >2 and who are not candidates for further CT had a dismal prognosis and should probably not be offered PTBD.
authors.affiliation: Division of Medical Oncology, Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, marcela.teixeira@icesp.org.br.
authors.forename: Marcela
authors.initials: M
authors.lastname: Crosara Teixeira
authors.forename: Milena Perez
authors.initials: MP
authors.lastname: Mak
authors.forename: Daniel Fernandes
authors.initials: DF
authors.lastname: Marques
authors.forename: Fernanda
authors.initials: F
authors.lastname: Capareli
authors.forename: Francisco Cesar
authors.initials: FC
authors.lastname: Carnevale
authors.forename: Airton Mota
authors.initials: AM
authors.lastname: Moreira
authors.forename: Ulysses
authors.initials: U
authors.lastname: Ribeiro
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
authors.forename: Paulo M
authors.initials: PM
authors.lastname: Hoff
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality* / Q000473:pathology*; D011379:Prognosis; D015996:Survival Rate