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A scoring model to predict the clinical outcome of self-expandable metal stents in patients with colorectal obstruction due to extracolonic malignancy
Background
Self-expandable metal stents (SEMS) can be applied to relieve colorectal obstruction secondary to extracolonic malignancy (ECM), but data regarding this issue is sparse. We aimed to investigate the predictive factors for technical and clinical success of SEMS placement and develop simple and useful strategies for predicting the clinical outcome of SEMS placement in patients with colorectal obstruction due to ECM.
Methods
Between January 2006 and December 2018, patients with colorectal obstruction due to ECM who had underwent SEMS placement were recruited. After identifying independent predictive factors for success of SEMS placement, we developed a prediction model using logistic analysis. The model was built and validated in a training and a validation data set, respectively. Using the model, we risk stratified patients into low-, intermediate-, and high-risk groups.
Results
A total of 315 patients were identified. Overall, 282 patients (89.5%) achieved technical success, and 226 patients (71.7%) achieved clinical success. Multivariate logistic analysis showed that severe peritoneal thickening and omental infiltration, soft tissue nodule ≥ 1 cm, bowel involvement length ≥ 4 cm, and serum albumin level ≤ 3.3 mg/dL were independently associated with a higher risk for failure of SEMS placement. The prediction model that incorporated these factors had an area under the receiver operating characteristic curve of 0.73 (95% CI 0.65–0.81) for the training data and 0.71 (95% CI 0.60–0.82) for the validation data. Patients with low-, intermediate-, and high-risk scores had a predicted the failure of SEMS placement of 13.4%, 28.1%, and 67.4%, respectively.
Conclusions
We developed a reliable prediction model that was able to risk stratify patients into low-, intermediate-, and high-risk groups. This prediction model incorporating the four variables may be useful for selecting patients who benefit from SEMS placement for colorectal obstruction caused by ECM.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
