title: Inflammation-based prognostic score predicts biliary stent patency in patients with unresectable malignant biliary obstruction.
abstract: BACKGROUND
  An inflammation-based prognostic score, the modified Glasgow prognostic score (mGPS), has been reported to be useful for predicting postoperative survival in patients with various types of cancer. However, no studies have investigated whether the mGPS can predict biliary stent (BS) patency in patients undergoing BS placement for unresectable malignant biliary obstruction (UMBO).
  
  
  OBJECTIVE
  To evaluate the usefulness of the mGPS for predicting BS patency in patients undergoing intraoperative placement of uncovered expandable metallic stents (EMSs) for UMBO.
  
  
  METHODS
  The mGPS was calculated as follows: patients with both an elevated C-reactive protein (CRP) level (>1.0 mg/dl) and hypoalbuminemia (<3.5 g/dl) were allocated a score of 2. Patients with only an elevated CRP level were allocated a score of 1, and patients without an elevated CRP level were allocated a score of 0. EMS patency was compared by Kaplan-Meier analysis and log-rank test between the two groups (mGPS 0 vs. mGPS 1 or 2). The significant risk factors for EMS occlusion were investigated by Cox proportional hazards model analysis.
  
  
  RESULTS
  Kaplan-Meier analysis revealed that patients with mGPS 1 (n=7) and 2 (n=19) had a lower EMS patency rate (p=0.014) than patients with mGPS 0 (n=37). Although univariate analyses revealed that a high serum total bilirubin level, stent-in-stent placement, and mGPS 1 or 2 were significant risk factors predictive of EMS occlusion, multivariate analysis demonstrated that no independent risk factors were significant.
  
  
  CONCLUSIONS
  mGPS is a significant predictor of EMS patency in patients undergoing intraoperative placement of BS.
authors: Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan yiwasaki@dokkyomed.ac.jp.
authors: Yoshimi
authors: Y
authors: Iwasaki
authors: Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
authors: Mitsuru
authors: M
authors: Ishizuka
authors: Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
authors: Masato
authors: M
authors: Kato
authors: Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
authors: Junji
authors: J
authors: Kita
authors: Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
authors: Mitsugi
authors: M
authors: Shimoda
authors: Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
authors: Keiichi
authors: K
authors: Kubota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002779:Cholestasis / Q000473:pathology* / Q000601:surgery*; D004067:Digestive System Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015607:Stents
keywords: Biliary stent; Glasgow prognostic score; mGPS; stent patency; unresectable malignant biliary obstruction