Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China.
Shanghai Institution of Medical Imaging, Shanghai, China.
Brachytherapy. 2021 Mar-Apr;20(2):446-453. doi: 10.1016/j.brachy.2020.10.004. Epub 2020 Dec 8.
The purpose of this study was to assess the efficacy of an iodine-125 (I) seed strand combined with a metal stent compared with a metal stent for treatment of obstructive jaundice caused by pancreatic ductal adenocarcinoma (PDAC).
A retrospective analysis was carried out of patients who were referred to Shanghai Zhongshan Hospital of Fudan University with a diagnosis of PDAC between January 1, 2010 and January 31, 2019. A total of 110 consecutive patients with obstructive jaundice caused by PDAC were divided into the iodine-125 seed strand combined with a metal stent group (Group A = 48) and the metal stent group (Group B = 62). The primary outcome was stent obstruction-free survival time, and secondary outcomes were overall survival and complications.
The median stent obstruction-free survival time was 133.0 (95% confidence interval (CI): 166.093-149.907) days, and the median overall survival was 212.0 (95% CI: 187.183-236.817) days in all patients. Median stent obstruction-free survival time was 175 days (95% CI 103.165-246.835 days) in Group A versus 120 days (95% CI 87.475-152.525 days) in Group B (p = 0.035). A lower Eastern Cooperative Oncology Group (ECOG) score (p = 0. 000) and iodine-125 seed strand combined with metal stent implantation (p = 0.008) were associated with a longer stent obstruction-free survival time. Obstruction length (p = 0.083), ECOG score (p = 0.000), and iodine-125 seeds (p = 0.037) might have potential impact on stent obstruction-free survival time and were included for multivariable analysis using the Cox proportional hazards model. Stent restenosis was observed in 18.8% (9/48) of patients in Group A and 54.8% (34/62) in Group B, respectively. There was no significant difference in median survival between Group A and Group B (p = 0.409). The median survival in Group A was 209 days (95% CI 150.750-267.250) and 202 days (95% CI 190.624-233.376) in Group B. The median survival of patients with a lower ECOG score was better than that of patients with a higher ECOG score (267 days vs 132 days, p = 0.000). The Grade 3 or 4 complications occurred in 4 (8.3%) of the 48 patients in Group A (one case of hemobilia, one case of liver abscess, two cases of choleperitonitis) and in 5 (8.1%) of the 62 patients in Group B (one case of hemobilia, two cases of liver abscess, two cases of choleperitonitis) (p = 0.972).
Implantation of an iodine-125 seed strand combined with a metal stent provides longer obstruction-free survival time compared with a metal stent in patients with obstructive jaundice caused by PDAC. It seems reasonable to choose an iodine-125 seed strand combined with a metal stent as a treatment for these patients.
本研究旨在评估碘 125（I）种子 strand 联合金属支架与金属支架治疗胰腺导管腺癌（PDAC）引起的梗阻性黄疸的疗效。
对 2010 年 1 月 1 日至 2019 年 1 月 31 日期间在复旦大学中山医院就诊的 PDAC 患者进行回顾性分析。共纳入 110 例 PDAC 所致梗阻性黄疸患者，分为碘 125 种子 strand 联合金属支架组（A 组=48 例）和金属支架组（B 组=62 例）。主要结局为支架无阻塞生存时间，次要结局为总生存和并发症。
所有患者的中位支架无阻塞生存时间为 133.0（95%置信区间[CI]：166.093-149.907）天，中位总生存时间为 212.0（95%CI：187.183-236.817）天。A 组中位支架无阻塞生存时间为 175 天（95%CI 103.165-246.835 天），B 组为 120 天（95%CI 87.475-152.525 天）（p=0.035）。ECOG 评分较低（p=0.000）和碘 125 种子 strand 联合金属支架植入（p=0.008）与支架无阻塞生存时间较长相关。阻塞长度（p=0.083）、ECOG 评分（p=0.000）和碘 125 种子（p=0.037）可能对支架无阻塞生存时间有潜在影响，并纳入 Cox 比例风险模型进行多变量分析。A 组 18.8%（9/48）的患者出现支架再狭窄，B 组 54.8%（34/62）的患者出现支架再狭窄。A 组和 B 组中位生存时间无显著差异（p=0.409）。A 组中位生存时间为 209 天（95%CI 150.750-267.250），B 组为 202 天（95%CI 190.624-233.376）。ECOG 评分较低的患者中位生存时间优于 ECOG 评分较高的患者（267 天 vs 132 天，p=0.000）。A 组有 4 例（8.3%）患者出现 3 级或 4 级并发症（1 例胆道出血，1 例肝脓肿，2 例胆腹膜炎），B 组有 5 例（8.1%）患者出现 3 级或 4 级并发症（1 例胆道出血，2 例肝脓肿，2 例胆腹膜炎）（p=0.972）。
碘 125 种子 strand 联合金属支架治疗 PDAC 引起的梗阻性黄疸可延长无阻塞生存时间，优于金属支架。对于这些患者，选择碘 125 种子 strand 联合金属支架治疗似乎是合理的。
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