KEY TAKEAWAYS
- The study aimed to investigate the effectiveness of SEMS in improving dysphagia and its impact on prognosis in initially frail patients with advanced EC.
- Researchers found that SEMS relieved dysphagia but did not improve prognosis.
The post-insertion clinical course of esophageal self-expandable metal stents (SEMS) in initially frail patients with esophageal carcinoma (EC) and dysphagia remains unclear.
Mitsuhiro Furuta and the team aimed to assess the degree of dysphagia improvement and evaluate the overall prognosis in initially frail patients with advanced EC following SEMS insertion.
They performed an inclusive analysis of patients with EC who underwent esophageal SEMS insertion at their institution between January 2014 and March 2023. Patients included in the study were those with an Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 3 or higher, or those aged 75 years and older with an ECOG PS of 2.
All patients were recommended for best supportive care by a multidisciplinary team, ensuring that the cohort consisted of individuals for whom curative or aggressive anticancer treatments were deemed unsuitable.
About 46 patients met the inclusion criteria, with 37 of them (80.4%) being 75 years or older, and 21 patients (45.7%) presenting with an ECOG PS of 3 or 4. Dysphagia scores (DS) of 3 or higher were observed in 27 patients (58.7%). All esophageal SEMS insertions were successfully performed.
However, there were 2 fatal cases of aspiration pneumonia and 1 incident of perforation post-procedure. DS improved to 1 or lower in 25 patients (54.3%). Multivariate analysis identified DS 3-4 and Glasgow Prognostic Score (GPS) 1-2 as negative predictive factors. The median overall survival (OS) for the cohort was 4.1 months, with a 95% CI of 1.8-6.5 months.
The study concluded that esophageal SEMS insertion effectively alleviated dysphagia in initially frail patients with EC; however, the overall prognosis remained poor, with some patients experiencing fatal adverse events (AEs).
The findings underscore the importance of careful candidate selection for SEMS insertion, particularly in patients with high (DS 3-4) and unfavorable Glasgow Prognostic Scores (GPS 1-2), as these factors present significant challenges in achieving meaningful improvement in dysphagia and overall outcomes.
The study received no funds.
Source: https://pubmed.ncbi.nlm.nih.gov/39143477/
Furuta M, Hayashi K, Watanabe M, et al. (2024). “Palliative use of self-expanding metal stents in initially anticancer treatment-intolerant patients with esophageal cancer.” BMC Gastroenterol. 2024 Aug 14;24(1):264. doi: 10.1186/s12876-024-03329-1. PMID: 39143477; PMCID: PMC11323342.
