| Purpose:The long-term efficacy and safety of a novel release system of through-the-scope(TTS)airway stent implantation in patients with malignant central airway obstruction are being further observed.Methods:The data of 90 patients with malignant central airway obstruction(MCAO)who were treated with airway stents at the First Hospital of Soochow University,Dushu Lake Hospital of Soochow University and Suzhou Municipal Hospital from May 2017 to January 2023 and followed up by tracheoscopy wereretrospectively analysed.Of these,48 had TTS metal airway stents and 42 had other types(OTW or Ultraflex)of metal airway stents.The pre/post-operative airway stenosis rate,dyspnoea score,stent-related complications at different follow-up times(within 2 weeks,2-4 weeks,4-8 weeks,after 8 weeks),one-time placement success rate and overall placement success rate were evaluated.Risk factors associated with the prognosis of TTS metal airway stents were analysed by COX modelling.All patients were followed up until death or at least 24 months and overall survival(OS)was counted.Results:1.The degree of dyspnea[mMRC score(3.06±0.70)vs.(1.40±0.82),P<0.001]and airway stenosis[(86.19±10.09)%vs.(31.80±9.86)%,P<0.001]were significantly improved in patients with TTS stents within 3 days after surgery compared with those before surgery.2.The procedure time was significantly shorter in the TTS group than in the other stent groups[76(50-137)s vs.311(253-379)seconds,P<0.001].The stenting efficiency(100.00%vs.97.62%,P=0.315)and one-time stenting success rate(93.75%vs.85.71%,P=0.295)were slightly higher in the TTS group than in the other stenting groups,but the difference was not statistically significant.3.Complications after stent placement were dominated by sputum retention,restenosis and granulation tissue hyperplasia,with no statistical difference between the TTS stent group and the OTW/Ultraflex stent group.The incidence of granulomatous hyperplasia was lower in the TTS stent group than in the OTW/Ultraflex stent group(8.33%vs.11.90%,8.33%vs.14.29%,12.50%vs.23.81%and 10.42%vs.21.43%)within 2 weeks,2-4 weeks,4-8 weeks and after 8 weeks postoperatively,but none were statistically different.4.The median survival of patients with TTS stent placement was not statistically significantly different from that of patients with other stents(4.2 months vs.4.3 months,P=0.878).The median survival of patients with TTS stent placement alone was significantly lower than that of patients receiving postoperative oncology-related treatment(2.1 months vs.5.7 months,P<0.001).5.Logistic regression analysis showed that increased neutrophils were a risk factor for granulation tissue proliferation after 4 weeks(OR=1.223;95%CI,0.969～1.544).6.Cox model analysis showed that KPS score and postoperative combined anti-tumour therapy were the main influencing factors for survival after stent placement in MCAO patients.Conclusion:1.The TTS stent can rapidly reduce airway stenosis and relieve symptoms such as dyspnoea in patients with MCAO.Stent placement time was significantly reduced compared to OTW/Ultraflex stents.2.Compared with the conventional OTW/Ultraflex stent,there was no increase in the incidence of complications associated with the TTS stent.The incidence of sarcomeres,particularly distal sarcomeres,was slightly lower than with the OTW/Ultraflex stent.3.KPS scores,and combined anti-tumour therapy after stent placement,were the main factors affecting the prognosis of patients with TTS stent placement.4.An increase in neutrophil values was a risk factor for granulomatous hyperplasia 4 weeks after stent placement. |
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