Poster Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

Predicting benefit from oesophageal stenting in patients with advanced cancer: an application of prognostic tools retrospectively to find trends in survival. (126622)

Aaditi Padhi 1 2 , Caitlin Sheehan 3
  1. New South Wales Health- Western Sydney Local Health District, Leichhardt, NEW SOUTH WALES, Australia
  2. Palliative Care, New South Wales Health, Sydney, NSW, Australia
  3. Palliative Care, New South Wales Health , Sydney

Background

Oesophageal stenting to manage malignant dysphagia is associated with significant morbidity and mortality. Whilst used to relieve obstructive symptoms, predicting benefit from stenting is difficult in advanced malignancy. The Palliative Prognostic Index (PPI) is a validated prognostic tool used to predict survival of less than 6 weeks with 80% sensitivity, that may be used to assist with clinical decision making.

 

Methods

This was a single-centre retrospective analysis to assess the utility of the PPI in predicting median survival post-oesophageal stenting in patients with dysphagia secondary to advanced malignancy over a 5-year period (n=66). The PPI was applied via retrospective record review and was used to stratify patients into three risk groups: low-risk PPI1 (PPI>6), medium-risk PPI2 (PPI=4-6) and high-risk PPI3 (PPI<4). The primary outcome was an observed difference between survival times in each prognostic score group. Patients were also stratified based on their Clinical Frailty Score (CFS) and Eastern Cooperative Oncology Group (ECOG) performance status. Secondary outcomes included increased opioid use, recurrence of obstructive symptoms, re-intervention and discharge destination.

 

Impact on practice

PPI is an independent prognostic factor of overall survival after oesophageal stent insertion. It may be used to assist clinicians in identifying those patients at high-risk of short-term mortality poststent.

 

Discussion

PPI in conjunction with performance status, frailty and other treatments could help identify the small group that may not benefit from oesophageal stenting. There was a statistically significant increase in the hazard ratio for post-stent mortality with increasing PPI scores; HR for PPI2 was 2.3 and for PPI3 was 10.6 compared with PPI1. Patients identified as low-risk (95.7%) were more likely to be discharged home than those identified as medium (71.9%) or high risk (36.4%). Medium or high-risk patients require further discussion on whether oesophageal stenting is line with their goals of care.