Prognostic factors and clinical outcomes of stenting on malignant central airway obstruction

Various therapeutic bronchoscopy techniques, including stenting, are widely utilized in the treatment of malignant central airway obstruction (MCAO), however, little data exist on the independent clinical outcomes and prognostic factors of airway stenting on MCAO. We retrospectively analyzed 287 eligible patients with MCAO who underwent therapeutic bronchoscopy at the Department of Pulmonary and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, between January 1, 2016, and May 31, 2023. The length of survival was measured in months from the date of the first bronchoscopy procedure to the date of death, or until six months post-procedure or loss to follow-up. Dyspnea was assessed using the Borg score, modified Medical Research Council (mMRC), and 6-minute walk distance (6MWD), while quality of life (QoL) was evaluated using the Short Form 6-Dimension (SF-6D) and Karnofsky Performance Status (KPS) score. All assessments were conducted consecutively at baseline, three months, and six months following the procedure. The overall survival rate was illustrated using the Kaplan-Meier curve, and the Cox proportional hazards mode were applied to evaluate multiple prognostic factors affecting survival in both groups over a 6-month follow-up period. A total of 287 patients were analyzed, including 215 in the stent group and 72 in the non-stent group. A significant difference in lesion location was observed between the groups. Postoperative stenosis was significantly improved in the stent group, with 94.41% achieving grade I stenosis compared to 8.33% in the non-stent group (P = 0.001). The stent group also showed greater improvements in KPS, Borg scores, SF-6D, and 6MWD compared to the non-stent group (P = 0.001). Additionally, significant improvements in Borg score, mMRC, 6MWD, KPS, and SF-6D were maintained at three- and six-month follow-ups. The mean survival period was significantly longer in the stent group (5.1 months) compared to the non-stent group (4.6 months). The Cox proportional hazards model identified the type of stenosis (HR: 0.184, 95% CI: 0.047-0.968, P = 0.015) and the degree of stenosis after the procedure (HR: 0.211, 95% CI: 0.061-0.726, P = 0.014) as significant factors influencing survival outcomes. Airway stenting is a safe and effective procedure leading to significant improvements in clinical symptoms and QoL for patients with MCAO at a 6-month follow-up. The type and severity of stenosis were identified as significant prognostic factors for survival.