Clinical and radiographic predictors of successful therapeutic bronchoscopy for the relief of malignant central airway obstruction.

Abstract

BACKGROUND:Malignant central airway obstruction (CAO) occurs in approximately 20-30% of patients with lung cancer and is associated with debilitating symptoms and poor prognosis. Multimodality therapeutic bronchoscopy can relieve malignant CAO, though carries risk. Evidence to guide clinicians regarding which patients may benefit from such interventions is sparse. We aimed to assess the clinical and radiographic predictors associated with therapeutic bronchoscopy success in relieving malignant CAO. METHODS:We reviewed all cases of therapeutic bronchoscopy performed for malignant CAO at our institution from January 2010-February 2017. Therapeutic bronchoscopy success was defined as establishing airway patency of > 50%. Patient demographics and baseline characteristics, oncology history, degree of airway obstruction, procedural interventions, and complications were compared between successful and unsuccessful groups. Univariate and multivariate logistic regression identified the significant clinical and radiographic predictors for therapeutic success. The corresponding simple and conditional odds ratio were calculated. A time-to-event analysis with Kaplan-Meier plots was performed to estimate overall survival. RESULTS:During the study period, 301 therapeutic bronchoscopies were performed; 44 (14.6%) were considered unsuccessful. Factors associated with success included never vs current smoking status (OR 5.36, 95% CI:1.45-19.74, p = 0.010), patent distal airway on CT imaging (OR 15.11, 95% CI:2.98-45.83, p < 0.0001) and patent distal airway visualized during bronchoscopy (OR 10.77, 95% CI:3.63-31.95, p < 0.001) in univariate analysis. Along with patent distal airway on CT imaging, increased time from radiographic finding to therapeutic bronchoscopy was associated with lower odds of success in multivariate analysis (OR 0.96, 95% CI:0.92-1.00, p = 0.048). Median survival was longer in the successful group (10.2 months, 95% CI:4.8-20.2) compared to the unsuccessful group (6.1 months, 95% CI:2.1-10.8, log rank p = 0.015). CONCLUSIONS:Predictors associated with successful therapeutic bronchoscopy for malignant CAO include distal patent airway visualized on CT scan and during bronchoscopy. Odds of success are higher in non-smokers, and with decreased time from radiographic finding of CAO to intervention.

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Published Version (Please cite this version)

10.1186/s12890-019-0987-3

Publication Info

Giovacchini, Coral X, Edward R Kessler, Christopher M Merrick, Junheng Gao, Xiaofei Wang, Momen M Wahidi, Scott L Shofer, George Z Cheng, et al. (2019). Clinical and radiographic predictors of successful therapeutic bronchoscopy for the relief of malignant central airway obstruction. BMC pulmonary medicine, 19(1). p. 219. 10.1186/s12890-019-0987-3 Retrieved from https://hdl.handle.net/10161/28644.

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Scholars@Duke

Giovacchini

Coral Xantia Giovacchini

Assistant Professor of Medicine
Wang

Xiaofei Wang

Professor of Biostatistics & Bioinformatics

Design and Analysis of Clinical Trials
Methods for Diagnostic and Predictive Medicine
Survival Analysis
Causal Inference
Analysis of Data from Multiple Sources


Wahidi

Momen Mohammed Wahidi

Adjunct Professor in the Department of Medicine

Emphysema, Lung Nodules, Lung Cancer, Bronchoscopy, Pleural Diseases

Shofer

Scott Leigh Shofer

Associate Professor of Medicine
Mahmood

Kamran Mahmood

Associate Professor of Medicine

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