Stenting as a bridge to surgery in obstructing colon cancer: Long-term recurrence pattern and competing risk of mortality

Table 1 Demographics and clinicopathological characteristics of 62 patients undergoing stenting as a bridge to curative surgery for obstructing colon cancer

Variables	n = 62
Age (yr, median [range])	70.0 [37.0, 90.0]
Sex
Female	25 (40.3)
Male	37 (59.7)
ASA classification
I	11 (17.7)
II	43 (69.4)
III	8 (12.9)
IV	0 (0.0)
Diabetes mellitus
No	50 (80.6)
Yes	12 (19.4)
Albumin (g/dL)
Median [range]	3.65 [1.90, 4.60]
≥ 3.0	52 (83.9)
< 3.0	10 (16.1)
CEA (µg/L)
Median [range]	5.75 [0.95, 84.4]
< 5.3	28 (45.2)
≥ 5.3	34 (54.8)
Tumour location
Rectosigmoid	8 (12.9)
Sigmoid	26 (41.9)
Descending	17 (27.4)
Splenic flexure	11 (17.7)
Tumour staging
T2	1 (1.6)
T3	47 (75.8)
T4	14 (22.6)
Nodal involvement
N0	27 (43.5)
N1	23 (37.1)
N2	12 (19.4)
Tumour differentiation
Well differentiated	2 (3.2)
Moderately differentiated	59 (95.2)
Poorly differentiated	1 (1.6)
Histology
Adenocarcinoma	59 (95.2)
Mucinous adenocarcinoma	3 (4.8)
Tumour deposit(s)
No	50 (80.6)
Yes	12 (19.4)
Microscopic margin involvement (R1 resection)
No	58 (93.5)
Yes	4 (6.5)
Perineural infiltration
No	40 (64.5)
Yes	22 (35.5)
Lymphovascular invasion
No	43 (69.4)
Yes	19 (30.6)
Pericolic microabscess
No	54 (87.1)
Yes	8 (12.9)
Stent failure
No	57 (91.9)
Yes	5 (8.1)
Surgical approach
Open	33 (53.2)
Laparoscopic	29 (46.8)
Stoma formation
No	58 (93.5)
Yes	4 (6.5)
Adjuvant chemotherapy
No	31 (50.0)
Yes	31 (50.0)
Perioperative major complication(s)
No	58 (93.5)
Yes	4 (6.5)
Postoperative 30 d mortality
No	61 (98.4)
Yes	1 (1.6)
Postoperative 90 d mortality
No	60 (96.8)
Yes	2 (3.2)

Values are presented as median [range] or number (%). ASA: American Society of Anaesthesiologists; CEA: Carcinoembryonic antigen.

Table 2 Cumulative incidence of colorectal cancer-specific death by potential risk factors after endoscopic stenting followed by curative resection

Variable	CRC-specific death (mo)
	12	36	60
Age
< 70 yr	0.00	0.22	0.37
≥ 70 yr	0.06	0.10	0.21
Sex
Female	0.04	0.27	0.45
Male	0.03	0.09	0.20
Stent failure
No	0.04	0.15	0.31
Yes	0.00	0.25	0.25
Surgical approach
Open	0.06	0.16	0.22
Laparoscopic	0.00	0.15	0.40
T4 staging
No	0.04	0.14	0.18
Yes	0.00	0.23	0.62
N2
No	0.02	0.13	0.26
Yes	0.09	0.27	0.36
Tumour deposit(s)
No	0.04	0.13	0.26
Yes	0.00	0.28	0.40
Microscopic margin involvement (R1 resection)
No	0.04	0.15	0.29
Yes	0.00	0.25	0.25
Histology
Adenocarcinoma	0.02	0.15	0.29
Mucinous adenocarcinoma	0.33	0.33	0.33
Poorly differentiated
No	0.03	0.16	0.30
Yes	0.00	0.00	0.00
Perineural infiltration
No	0.05	0.08	0.17
Yes	0.00	0.30	0.52
Lymphovascular invasion
No	0.02	0.10	0.10
Yes	0.06	0.30	0.64
Pericolic microabscess
No	0.04	0.14	0.29
Yes	0.00	0.29	0.29
Albumin (g/dL)
≥ 3.0	0.02	0.15	0.26
< 3.0	0.10	0.21	0.56
CEA (µg/L)
< 5.3	0.00	0.13	0.22
≥ 5.3	0.06	0.18	0.35
ASA classification
I/II	0.02	0.12	0.28
III	0.13	0.38	0.38
Diabetes mellitus
No	0.04	0.13	0.28
Yes	0.00	0.25	0.35
Perioperative major complication(s)
No	0.04	0.15	0.29
Yes	0.00	-	-
Adjuvant chemotherapy
No	0.03	0.07	0.21
Yes	0.03	0.24	0.37
Lung-only recurrence
No	0.04	0.16	0.28
Yes	0.00	0.13	0.34
Liver-only recurrence
No	0.04	0.12	0.24
Yes	0.00	0.38	0.69
Peritoneum-only recurrence
No	0.00	0.07	0.12
Yes	0.12	0.38	0.65
≥ 2 sites of recurrences
No	0.04	0.10	0.23
Yes	0.00	0.44	0.63

CRC: Colorectal cancer; ASA: American Society of Anaesthesiologists; CEA: Carcinoembryonic antigen.

Table 3 Fine-Gray regression analysis for colorectal cancer-specific death under the competing risk of other cause-specific death

Variable	CRC-specific death
	Univariate		Multivariate
	SHR (95%CI)	P value	SHR (95%CI)	P value
Age ≥ 70 yr	0.84 (0.33, 2.15)	0.710
Sex (Male)	0.49 (0.19, 1.28)	0.150
Laparoscopic surgery	1.28 (0.49, 3.33)	0.610
Stent failure	0.58 (0.06, 5.51)	0.630
T4 staging	1.23 (0.97, 1.57)	0.088
N2	2.44 (0.88, 6.75)	0.086
Tumour deposit(s)	2.02 (0.74, 5.56)	0.170
Microscopic margin involvement (R1 resection)	1.68 (0.58, 4.84)	0.340
Mucinous components	3.35 (0.72, 15.5)	0.120
Poorly differentiated	2.67 (1.50, 4.76)	< 0.001	1.11 (0.32, 3.83)	0.870
Perineural infiltration	2.34 (0.89, 6.17)	0.086
Lymphovascular invasion	3.99 (1.55, 10.3)	0.004	1.98 (0.61, 6.49)	0.260
Pericolic microabscess	1.12 (0.25, 5.04)	0.880
Albumin < 3.0 g/dL	1.36 (0.38, 4.90)	0.640
CEA ≥ 5.3 µg/L	2.45 (0.80, 7.53)	0.120
ASA classification III	1.10 (0.68, 1.80)	0.700
Diabetes mellitus	2.02 (0.75, 5.49)	0.170
Perioperative major complication(s)	1.26 (0.16, 9.78)	0.820
Adjuvant chemotherapy	1.37 (0.54, 3.46)	0.500
Lung-only recurrence	0.69 (0.19, 2.51)	0.570
Liver-only recurrence	4.25 (0.98, 18.4)	0.049	41.0 (5.01, 336)	< 0.001
Peritoneum-only recurrence	4.53 (1.79, 11.5)	0.001	23.2 (2.92, 185)	0.003
≥ 2 sites of recurrences	1.96 (1.19, 3.23)	0.008	5.28 (1.80, 15.4)	0.002

CRC: Colorectal cancer; SHR: Subdistribution hazard ratio; CI: Confidence interval; ASA: American Society of Anaesthesiologists; CEA: Carcinoembryonic antigen.