Department of Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy.
Radiology Unit, Department of Diagnostic and Preventive Medicine, S. Orsola-Malpighi University Hospital, Via Albertoni 15, 40138, Bologna, Italy.
Cardiovasc Intervent Radiol. 2020 Sep;43(9):1305-1314. doi: 10.1007/s00270-020-02569-4. Epub 2020 Jul 8.
Y90 transarterial radioembolization (Y90-RE) may improve clinical outcomes of unresectable intrahepatic cholangiocarcinoma (ICC); however, the optimal timing for Y90-RE is still debated. The purpose of this multicenter study was to retrospectively evaluate clinical outcomes of RE in patients with unresectable ICC, comparing three different settings: chemotherapy naïve patients (group A), patients with disease control after first-line chemotherapy (group B) and patients with progression after first-line chemotherapy (group C).
The study included 81 consecutive patients (49 male, mean age 62.4 ± 11.8 years): 35 (43.2%) patients were in group A, 19 (23.5%) in group B, and 27 (33.3%) in group C. Preprocedural clinical variables, tumour response according to RECIST 1.1 and overall survival (OS) were analysed and compared.
Baseline demographic and clinical features did not differ significantly among groups, with the exception of prior surgical procedures that were significantly higher in group C patients, and macrovascular invasion that was more frequent in group B. Radiological response was available in 79 patients; objective response and disease control rates were 41.8% and 83.6%, respectively, without significant differences among groups. Median OS was 14.5 months (95% CI: 11.1-16.9) and was not significantly different among treatment groups. At multivariate analysis, tumour burden > 50%, neutrophil-to-lymphocyte (N/L) ratio ≥ 3 and radiological progression as best response resulted to be significant (P < 0.05) independent factors, negatively associated with OS.
Y90-RE is a valuable treatment option in unresectable ICC, irrespectively from the timing of treatment. Tumour extension, N/L ratio and radiological response affect post-treatment survival.
钇 90 经动脉放射栓塞术（Y90-RE）可能改善不可切除的肝内胆管癌（ICC）的临床结果；然而，Y90-RE 的最佳时机仍存在争议。本多中心研究的目的是回顾性评估不可切除 ICC 患者接受 RE 的临床结果，比较三种不同的治疗设置：化疗初治患者（A 组）、一线化疗后疾病控制的患者（B 组）和一线化疗后进展的患者（C 组）。
本研究纳入了 81 例连续患者（49 例男性，平均年龄 62.4±11.8 岁）：35 例（43.2%）患者为 A 组，19 例（23.5%）为 B 组，27 例（33.3%）为 C 组。分析并比较了患者的术前临床变量、根据 RECIST 1.1 标准的肿瘤反应和总生存期（OS）。
各组之间的基线人口统计学和临床特征无显著差异，除了 C 组患者的先前手术比例明显更高，以及 B 组患者的大血管侵犯更为常见。79 例患者可获得影像学反应；客观缓解率和疾病控制率分别为 41.8%和 83.6%，各组之间无显著差异。中位 OS 为 14.5 个月（95%CI：11.1-16.9），各组之间无显著差异。多因素分析显示，肿瘤负荷>50%、中性粒细胞与淋巴细胞比值（N/L）≥3 和影像学进展为最佳反应是与 OS 显著相关的独立负相关因素（P<0.05）。
Y90-RE 是不可切除 ICC 的一种有价值的治疗选择，与治疗时机无关。肿瘤的扩展、N/L 比值和影像学反应影响治疗后的生存。
