Abstract
Anemia is known to correlate with tumor progression, which can result in narrowing of the airways. Although therapeutic bronchoscopy effectively manages central airway stenosis, restenosis frequently occurs. This study aimed to examine the relationship between hemoglobin levels and the risk of malignant central airway (MCA) restenosis in patients with lung squamous cell carcinoma (LUSC) undergoing interventional bronchoscopy. Data were collected from 196 LUSC patients with MCA stenosis who underwent therapeutic bronchoscopy between April 2014 and November 2023 at a tertiary hospital. Rates of MCA restenosis at 30 and 60 days post-therapeutic bronchoscopy were assessed. Piecewise linear regression, Cox regression analyses, and survival analysis were used to evaluate the impact of hemoglobin levels on restenosis risk, adjusting for potential confounders. The 30-day and 60-day rates of MCA restenosis were 27.0% and 56.1%, respectively. Hemoglobin levels, categorized into four groups, showed a significant trend of increased restenosis risk with decreasing levels (P for trend < 0.01), particularly pronounced in patients with hemoglobin levels < 120 g/L. Compared to those with hemoglobin ≥ 120 g/L, adjusted hazard ratios (aHRs) for restenosis were elevated at both 30-day (aHR 2.21, 95% CI 1.17-4.16) and 60-day (aHR 1.85, 95% CI 1.20-2.86). Interaction analysis indicated higher restenosis risk trends among patients ≤ 60 years old and those who received stent implantation. Anemia is linked to a heightened risk of MCA restenosis in patients with LUSC after interventional bronchoscopy, especially noticeable among younger patients. Moreover, stent implantation did not mitigate the risk of MCA restenosis within 2 months.