Annals of the American Thoracic Society · 2026
Real-world faceoff: EBRT vs interventions for malignant central airway obstruction.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Mathew Roshen, Meena Nikhil, Dalar Levent, Ayten Ömer, Özdemir Cengiz, Atasever Furkan
Аннотация
BACKGROUND: Malignant central airway obstruction (MCAO) is a life-threatening complication in thoracic oncology. While external beam radiation therapy (EBRT), stenting, bronchoscopic debulking, and combination approaches are widely used, real-world comparative survival data are limited.
METHODS: Using the TriNetX US Collaborative Network (2008-2023), we identified adults with MCAO undergoing EBRT (n = 11 478), stenting (n = 11 478), debulking (n = 7855), or stenting plus EBRT (n = 2985). Patients were 1:1 propensity-matched by demographics, cancer type, Eastern Cooperative Oncology Group (ECOG) status, and dyspnea. Kaplan-Meier and Cox proportional hazards models assessed survival; mortality risk was quantified with hazard ratios (HRs) and odds ratios (ORs) at multiple time points.
RESULTS: In matched cohorts (n = 11 478), EBRT was associated with longer median survival than stenting (1029 vs 627 days; HR, 0.776; P < .0001) and debulking (1068 vs 692 days; HR, 0.762; P < .0001), with no mortality difference (odds ratio [OR], 0.957 and P = .097; OR, 0.998 and P = .948, respectively). Compared with stent + EBRT (n = 2985), EBRT had superior survival (1003 vs 545 days; HR, 0.706; P < .0001) and lower mortality (OR, 0.659; P < .0001). Combination therapy offered no advantage over stenting alone and was associated with higher mortality (OR, 1.223; P = .000). Dyspnea independently predicted worse survival (HR, >2.0); age and ECOG were not significant predictors. The advantage of EBRT was greatest early. At 6 months, EBRT showed lower mortality than stenting (17.2% vs 23.5%; HR, 0.652), debulking (16.9% vs 23.0%; HR, 0.636), and stent + EBRT (20.2% vs 24.8%; HR, 0.808). One-year survival remained higher for EBRT vs stenting (87.7% vs 85.2%; HR, 0.813) and stent + EBRT (86.7% vs 84.1%; HR, 0.825). By 5 years, survival rates converged (eg, EBRT vs stenting: 60.1% vs 60.9%; HR, 0.983), with HRs approaching or exceeding 1 by 10 to 15 years, limiting long-term interpretation due to low event counts. In 7- and 30-day landmark analyses, EBRT showed significantly lower hazards of death vs all other modalities, with the largest relative benefit at 7 days (HR, 0.79-0.84; P < .001). Median survival remained longest with EBRT across all comparisons.
CONCLUSIONS: External beam radiation therapy confers early survival benefits over stenting, debulking, and combined therapy without increasing mortality. It should be considered first-line treatment for MCAO, reserving procedural interventions for patients with acute or complex airway compromise.
METHODS: Using the TriNetX US Collaborative Network (2008-2023), we identified adults with MCAO undergoing EBRT (n = 11 478), stenting (n = 11 478), debulking (n = 7855), or stenting plus EBRT (n = 2985). Patients were 1:1 propensity-matched by demographics, cancer type, Eastern Cooperative Oncology Group (ECOG) status, and dyspnea. Kaplan-Meier and Cox proportional hazards models assessed survival; mortality risk was quantified with hazard ratios (HRs) and odds ratios (ORs) at multiple time points.
RESULTS: In matched cohorts (n = 11 478), EBRT was associated with longer median survival than stenting (1029 vs 627 days; HR, 0.776; P < .0001) and debulking (1068 vs 692 days; HR, 0.762; P < .0001), with no mortality difference (odds ratio [OR], 0.957 and P = .097; OR, 0.998 and P = .948, respectively). Compared with stent + EBRT (n = 2985), EBRT had superior survival (1003 vs 545 days; HR, 0.706; P < .0001) and lower mortality (OR, 0.659; P < .0001). Combination therapy offered no advantage over stenting alone and was associated with higher mortality (OR, 1.223; P = .000). Dyspnea independently predicted worse survival (HR, >2.0); age and ECOG were not significant predictors. The advantage of EBRT was greatest early. At 6 months, EBRT showed lower mortality than stenting (17.2% vs 23.5%; HR, 0.652), debulking (16.9% vs 23.0%; HR, 0.636), and stent + EBRT (20.2% vs 24.8%; HR, 0.808). One-year survival remained higher for EBRT vs stenting (87.7% vs 85.2%; HR, 0.813) and stent + EBRT (86.7% vs 84.1%; HR, 0.825). By 5 years, survival rates converged (eg, EBRT vs stenting: 60.1% vs 60.9%; HR, 0.983), with HRs approaching or exceeding 1 by 10 to 15 years, limiting long-term interpretation due to low event counts. In 7- and 30-day landmark analyses, EBRT showed significantly lower hazards of death vs all other modalities, with the largest relative benefit at 7 days (HR, 0.79-0.84; P < .001). Median survival remained longest with EBRT across all comparisons.
CONCLUSIONS: External beam radiation therapy confers early survival benefits over stenting, debulking, and combined therapy without increasing mortality. It should be considered first-line treatment for MCAO, reserving procedural interventions for patients with acute or complex airway compromise.