title: Bronchoscopic debulking for endobronchial malignancy: Predictors of recanalization and recurrence.
abstract: BACKGROUND
  Central airway obstruction related to endobronchial malignancy is one of the most difficult oncological complications and requires efficient palliative intervention.
  
  
  METHODS
  Fifty-three consecutive patients with unresectable endobronchial malignancy receiving bronchoscopic cryotherapy as palliative treatment were retrospectively reviewed. Efficiency was evaluated by the improvement of performance status (PS), and the best achievement of tumor removal was assessed as complete or partial removal.
  
  
  RESULTS
  Patients' PS after cryotherapeutic tumor removal improved from the baseline PS (P = 0.006). In multivariate logistic regression analysis, the compression part of the tumor (odds ratio [OR] 0.42; 95% confidence interval [CI] 0.23∼0.75, P = 0.004) and the thin tumor stalk (OR 87.86; 95% CI 2.31∼3337.37, P = 0.016) were independent predictors of complete tumor removal. Tumors larger than 9.3 cm, including compression and invasion parts, had the highest odds of being only partially removed (positive predictive value [PPV]: 88.2%, likelihood ratio [LR]+: 10.49); tumors smaller than 9.3 cm were likely to be completely removed (negative predictive value [NPV]: 80.6%, LR-: 0.34). After cryotherapy, re-obstruction was significantly associated with non-squamous cell carcinoma (65.7 vs. 16.7%, P = 0.001) and patients who had longer overall survival (11.7 vs. 1.5 months, P < 0.001). Odds of tumor re-obstruction increased 2.28-fold (PPV: 81.6%, LR+: 2.28) beyond two months; the odds decreased by 81% (NPV: 73.3%, LR-: 0.19) within two months.
  
  
  CONCLUSIONS
  Debulking of a tumor using cryotherapy is a useful palliative treatment for endobronchial obstruction secondary to a variety of malignancies.
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine Taipei, Taiwan ; Department of Thoracic Medicine, Division of Oncology and Interventional Bronchoscopy, Chang Gung Memorial Hospital Taipei, Taiwan.
authors.forename: Scott Chih-Hsi
authors.initials: SC
authors.lastname: Kuo
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine Taipei, Taiwan ; Department of Thoracic Medicine, Division of Airway Diseases, Chang Gung Memorial Hospital Taipei, Taiwan ; Healthcare Center, Chang Gung Memorial Hospital Taipei, Taiwan.
authors.forename: Yu-Lun
authors.initials: YL
authors.lastname: Lo
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine Taipei, Taiwan ; Department of Thoracic Medicine, Division of Oncology and Interventional Bronchoscopy, Chang Gung Memorial Hospital Taipei, Taiwan.
authors.forename: Chun-Liang
authors.initials: CL
authors.lastname: Chou
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine Taipei, Taiwan ; Department of Thoracic Medicine, Division of Oncology and Interventional Bronchoscopy, Chang Gung Memorial Hospital Taipei, Taiwan.
authors.forename: Fu-Tsai
authors.initials: FT
authors.lastname: Chung
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine Taipei, Taiwan ; Department of Thoracic Medicine, Division of Airway Diseases, Chang Gung Memorial Hospital Taipei, Taiwan.
authors.forename: Shu-Min
authors.initials: SM
authors.lastname: Lin
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine Taipei, Taiwan ; Department of Thoracic Medicine, Division of Oncology and Interventional Bronchoscopy, Chang Gung Memorial Hospital Taipei, Taiwan.
authors.forename: Chien-Ying
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine Taipei, Taiwan ; Department of Thoracic Medicine, Division of Airway Diseases, Chang Gung Memorial Hospital Taipei, Taiwan.
authors.forename: Han-Pin
authors.initials: HP
authors.lastname: Kuo
keywords: Bronchoscopic; cryotherapy; endobronchial; malignancy