Early treatment burden predicts recurrence or progression after bronchoscopic intervention for infection- or injury-related benign airway stenosis: A two-center longitudinal cohort study

BackgroundPatients with infection- or injury-related benign airway stenosis often require repeated bronchoscopic interventions, but evidence is limited on how early treatment patterns can guide follow-up and risk reassessment.ObjectivesTo derive phase-adapted surveillance windows after bronchoscopic intervention and determine whether the 24-week treatment trajectory identifies patients at increased risk of subsequent recurrence or progression.DesignTwo-center retrospective longitudinal cohort study.MethodsPatients treated between January 2019 and December 2024 were included if they had infection- or injury-related benign airway stenosis and did not receive stent or T-tube placement during follow-up. Adjacent bronchoscopic records separated by ≤1 week were merged into one treatment episode. Valid intervals were defined as adjacent records separated by >1 week with assessable recurrence/progression status. Risk strata were constructed using treatment episodes within 24 weeks and window-end airway control: low risk, 1-3 episodes with adequate control; intermediate risk, 4-5 episodes or 1-3 episodes with inadequate control; and high risk, ≥6 episodes. A 24-week landmark analysis evaluated subsequent composite events.ResultsOverall, 213 patients contributed 879 valid intervals. Data-informed surveillance windows were approximately 1 week in the early phase, 2-3 weeks in the mid and consolidation phases, and 4-5 weeks in the maintenance phase. Among 93 patients included in landmark analysis, post-landmark composite event proportions were 31.3%, 60.9%, and 80.6% in the low-, intermediate-, and high-risk groups, respectively (log-rank P<0.001). In multivariable Cox regression, the high-risk group had a significantly increased risk of composite events (HR=5.849, 95% CI 2.031-16.845, P=0.001), whereas the intermediate-risk group showed a non-significant trend (HR=2.514, 95% CI 0.920-6.871, P=0.072).ConclusionEarly treatment burden provides clinically meaningful risk stratification after bronchoscopic intervention for benign airway stenosis. Six or more treatment episodes within 24 weeks may identify a treatment-dependent high-risk phenotype requiring intensified surveillance and comprehensive reassessment.