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PREOPERATIVE MEDICAL RESEARCH COUNCIL DYSPNEA SCALE AND ECOG PREDICT SURVIVAL IN PATIENTS UNDERGOING STENTING FOR MALIGNANT AIRWAY OBSTRUCTION

St-Luke's - Roosevelt Hospital Center, Columbia University College of Physicians, New York, NY

PURPOSE: Data regarding risk stratification of patients undergoing airway stenting for malignant airway obstruction is limited. We aimed to investigate correlation of survival with Medical Research Council (MRC) Dyspnea scale, Eastern Cooperative Oncology Group (ECOG) performance measures, Zubrod, and American Society of Anesthesiologists (ASA) scores in patients undergoing airway stenting for malignant airway obstruction.

METHODS: The study involved a retrospective analysis of all patients with complex malignant airway obstruction undergoing stenting over a two-year period (2007–2008) at our institution. SPSS 16.0 and Microsoft Excel were used to analyze the data. Statistical analysis was performed using Pearson Correlation and T-tests.

RESULTS: Stents were deployed in 41 patients. Successful patency of the airway was achieved in all patients with no procedure related mortality. Complications included mucous plugging (14%), tumor ingrowth (10%), and stent migration (2%). The pre and postoperative MRC scores were 3.46 and 2.39 (mean change = 1.07, p < 0.0001). The pre and postoperative ECOG scores were 3.36 and 2.21 (mean change = 1.15, p < 0.0001). Mean survival was 107 days. The overall 3- and 6-month survival was 44% and 22% respectively. Using Pearson Correlation (df = ± 0.257), preoperative MRC (r = –0.37) and ECOG (r = –0.40) scores significantly achieved negative correlation with survival. Correlation between survival and preoperative ASA (r = –0.16) and Zubrod scores (r = –0.137) were not significant. Similarly, age did not significantly correlate with survival (r = 0.05).

CONCLUSION: Our group of patients had very high pre-operative MRC and ECOG scores. We achieved significant improvement in both these performance measures after airway stenting. Further, high pre-operative MRC and ECOG scores accurately correlated with worse survival in these patients.

CLINICAL IMPLICATIONS: Airway stenting for malignant obstruction provides significant palliation of symptoms based on objective parameters such as MRC Dyspnea scale and ECOG score. It would also appear that early intervention, before significant deterioration has occurred in performance status, improves survival in this group of patients.

DISCLOSURE: Syed Razi, No Financial Disclosure Information; No Product/Research Disclosure Information