title: Simple Clinical Score to Predict 24-Week Survival Times in Patients with Inoperable Malignant Distal Biliary Obstruction as a Tool for Selecting Palliative Metallic or Plastic Stents.
abstract: OBJECTIVE
  Endoscopic biliary drainage (EBD) is the mainstay treatment for inoperable malignant distal biliary obstruction (MDBO). Some authorities suggest that metallic stents are more cost-effective than plastic stents in patients with expected survival of at least 6 months. However, studies attempting to define the predictive factors for such survival times are limited. This study aims to develop a scoring system for predicting a survival time of <24 weeks in these patients.
  
  
  METHODS
  Patients with MDBO from inoperable periampullary cancers who underwent EBD at Songklanagarind Hospital during 2004-2009 were retrospectively analyzed. Baseline clinical, laboratory, and imaging data were retrieved. The survival time data were retrieved from the medical records and Thailand's civil registration database. Multivariate Cox regression model coefficients were used in the development of a survival time prediction scoring system.
  
  
  RESULTS
  Ninety-eight patients were included. The overall median survival was 17.6 weeks. Fifty-seven (58.1%) survived <24 weeks. By multivariate analysis, cancer type and liver metastasis were significant predictive factors. The Simple Clinical Score (SCS) was calculated from (2× liver metastasis) + (1× pancreatic cancer) - (2× ampullary cancer) - (1× cholangiocarcinoma), when 1 and 0 were used for the presence and absence of each factor, respectively. The cutoff value of the score ≥0 had a sensitivity and specificity of 0.77 and 0.63, respectively, for predicting a survival time of <24 weeks, with AUC of 0.76. The median survival of patients with SCS <0 and ≥0 was 36.6 and 13.1 weeks, respectively.
  
  
  CONCLUSIONS
  The scoring system from this study may be beneficial for clinicians to select the appropriate stents in endoscopic biliary drainage in inoperable MDBO patients.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand. spimsiri@medicine.psu.ac.th.
authors.forename: Pimsiri
authors.initials: P
authors.lastname: Sripongpun
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
authors.forename: Siriboon
authors.initials: S
authors.lastname: Attasaranya
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
authors.forename: Naichaya
authors.initials: N
authors.lastname: Chamroonkul
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
authors.forename: Theerapong
authors.initials: T
authors.lastname: Sookpaisal
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
authors.forename: Uthai
authors.initials: U
authors.lastname: Khow-Ean
authors.affiliation: NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Prince of Songkla University, Hatyai, Songkhla, Thailand.
authors.forename: Aroon
authors.initials: A
authors.lastname: Siripun
authors.affiliation: Research Unit of Holistic Health and Safety Management in Community, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
authors.forename: Chanon
authors.initials: C
authors.lastname: Kongkamol
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
authors.forename: Teerha
authors.initials: T
authors.lastname: Piratvisuth
authors.affiliation: NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Prince of Songkla University, Hatyai, Songkhla, Thailand.
authors.forename: Bancha
authors.initials: B
authors.lastname: Ovartlarnporn
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D001662:Biliary Tract Surgical Procedures / Q000295:instrumentation / Q000379:methods; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002779:Cholestasis / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods; D015607:Stents
keywords: Ampullary cancer; Biliary stent; Cholangiocarcinoma; Distal biliary obstruction; Malignant biliary obstruction; Malignant distal biliary obstruction; Malignant distal biliary stricture; Metallic stents; Pancreatic cancer; Plastic stents; Predictive factors; Survival; Survival predictor