Department of Radiology, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, Sant'Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy.
Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
Cardiovasc Intervent Radiol. 2021 May;44(5):728-738. doi: 10.1007/s00270-021-02800-w. Epub 2021 Mar 11.
Intrahepatic cholangiocarcinoma (ICC) has a poor prognosis, when unresectable; therefore, intra-arterial therapies (IAT) such as trans-arterial chemoembolization (TACE) and trans-arterial radioembolization (TARE) have been employed. With the present systematic review and meta-analysis, we aimed to analyse published studies to understand if one IAT can be superior to the alternative.
A systematic search of PubMed and Web of Science databases was performed for articles published until 1 March 2020 relevant to IAT for ICC. Overall survival was the primary end point. Occurrence of clinical adverse events and tumour overall response were secondary outcome measures.
A total of 31 articles (of 793, n.1695 patients) were selected for data extraction, 13 were on TACE (906 patients) and 18 were on TARE (789 patients). Clinical and tumour characteristics showed moderate heterogeneity between the two groups. The median survival after TACE was 14.2 months while after TARE was 13.5 months (95%C.I.: 11.4-16.1). The survival difference was small (d = 0.112) at 1 year and negligible at 2 years (d = 0.028) and at 3 years (d = 0.049). The radiological objective response after TACE was 20.6% and after TARE was 19.3% (d = 0.032). Clinical adverse events occurred in 58.5% after TACE, more frequently than after TARE (43.0%, d = 0.314).
In conclusion, IATs are promising treatments for improving outcomes for patients with unresectable ICC. To date, TACE and TARE provide similar good outcomes, except for adverse events. Therefore, the decision about techniques is determined by ability to utilize these resources and patient specific factors (liver function or lesion dimension).
当不可切除时，肝内胆管癌（ICC）预后不良；因此，已经采用了经动脉治疗（IAT），如经动脉化疗栓塞（TACE）和经动脉放射性栓塞（TARE）。通过本系统回顾和荟萃分析，我们旨在分析已发表的研究，以了解一种 IAT 是否可以优于另一种 IAT。
对截至 2020 年 3 月 1 日在 PubMed 和 Web of Science 数据库中发表的与 ICC 的 IAT 相关的文章进行了系统检索。总生存率是主要终点。临床不良事件的发生和肿瘤总体反应是次要的观察指标。
共选择了 31 篇文章（793 篇文章中，n=1695 例患者）进行数据提取，其中 13 篇为 TACE（906 例患者），18 篇为 TARE（789 例患者）。两组患者的临床和肿瘤特征存在中度异质性。TACE 后中位生存期为 14.2 个月，TARE 后为 13.5 个月（95%CI：11.4-16.1）。1 年时的生存差异较小（d=0.112），2 年时的差异可以忽略不计（d=0.028），3 年时的差异也可以忽略不计（d=0.049）。TACE 后的影像学客观缓解率为 20.6%，TARE 后为 19.3%（d=0.032）。TACE 后发生临床不良事件的比例为 58.5%，高于 TARE（43.0%，d=0.314）。
总之，IAT 是改善不可切除 ICC 患者预后的有前途的治疗方法。到目前为止，TACE 和 TARE 提供了相似的良好结果，除了不良事件。因此，技术决策取决于利用这些资源的能力和患者的具体因素（肝功能或病变大小）。
