ELABORATION OF A PROGNOSTIC SCORE IN PATIENTS WITH MALIGNANT BILIARY OBSTRUCTION

Aims Endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) are the two minimally invasive procedures for inoperable malignant biliary obstruction. The medium-term survival of these patients after drainage is poorly documented in the literature. The goals of this study were: (a) to determine the clinical and biological factors associated with survival; and (b) to establish a prognostic score.

Methods All patients who had biliary drainage between April 1, 2014 and August 31, 2018 for inoperable malignant biliary obstruction were included. Clinical and biological baseline data were recorded retrospectively. The continuous variables of biological tests were analyzed by ROC curves. The survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test.

Results 262 patients were included with a mean age of 73 years. Biliary tract obstruction was due to primary cancer in 203 patients (77.5%) and metastases in 59 patients (22.5%). 373 procedures were performed with an average of 1.23 procedures per patient: 244 EBD, 127 PTBD and 2 combined procedures. Intra-hospital morbidity was 18.2%. The overall complication rate was no different between EBD and PTBD. The median survival rate was 4.8 months and 30-day mortality was 14%. Six variables were independently associated with poor prognosis: performans status, metastatic obstruction, liver metastases, weight loss > 5% in the last three months, albumin ≤ 24g/L, total bilirubin ≥ 186µmol/L. A prognostic score was calculated from these six variables. The median survival time was 7.5 months when the score was ≤ 2 and 2.5 months when it was > 2 (p < 0.001).

Conclusions A prognostic score was established on the basis of six variables and it was associated with poor survival when the score > 2. It may be useful in multidisciplinary meetings to make a decision based on the expected benefits and the risks inherent to the biliary drainage.