Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT.
Department of Gastroenterology and Hepatology, CHI-Creighton University Medical Center, Omaha, NE.
J Clin Gastroenterol. 2022 Feb 1;56(2):e153-e160. doi: 10.1097/MCG.0000000000001524.
Extrahepatic unresectable cholangiocarcinoma carries a dismal prognosis. In addition to biliary drainage by stent placement; photodynamic therapy (PDT) and radiofrequency ablation (RFA) have been tried to prolong survival. In this meta-analysis, we appraise the current known data on the use of PDT, RFA in the palliative treatment of extrahepatic unresectable cholangiocarcinoma.
We searched multiple databases from inception through July 2020 to identify studies that reported on PDT and RFA. Pooled rates of survival, stent patency, 30-, 90-day mortality, and adverse events were calculated. Study heterogeneity was assessed using I2% and 95% prediction interval.
A total of 55 studies (2146 patients) were included. A total of 1149 patients underwent treatment with PDT (33 studies), 545 with RFA (22 studies), and 452 patients with stent-only strategy. The pooled survival rate with PDT, RFA, and stent-only groups was 11.9 [95% confidence interval (CI): 10.7-13.1] months, 8.1 (95% CI: 6.4-9.9) months, and 6.7 (95% CI: 4.9-8.4) months, respectively. The pooled time of stent patency with PDT, RFA, and stent-only groups was 6.1 (95% CI: 4.2-8) months, 5.5 (95% CI: 4.2-6.7) months, and 4.7 (95% CI: 2.6-6.7) months, respectively. The pooled rate of 30-day mortality with PDT was 3.3% (95% CI: 1.6%-6.7%), with RFA was 7% (95% CI: 4.1%-11.7%) and with stent-only was 4.9% (95% CI: 1.7%-13.1%). The pooled rate of 90-day mortality with PDT was 10.4% (95% CI: 5.4%-19.2%) and with RFA was 16.3% (95% CI: 8.7%-28.6%).
PDT seemed to demonstrate better overall survival and 30-day mortality rates than RFA and/or stent-only palliation.
肝外不可切除的胆管癌预后极差。除了通过支架置入进行胆道引流外；还尝试了光动力疗法（PDT）和射频消融（RFA）来延长生存期。在这项荟萃分析中，我们评估了 PDT、RFA 在姑息治疗肝外不可切除胆管癌中的现有数据。
我们从成立到 2020 年 7 月在多个数据库中搜索，以确定报告 PDT 和 RFA 的研究。计算了生存率、支架通畅率、30 天和 90 天死亡率和不良事件的汇总率。使用 I²和 95%预测区间评估研究异质性。
共纳入 55 项研究（2146 例患者）。共有 1149 例患者接受 PDT 治疗（33 项研究），545 例接受 RFA 治疗（22 项研究），452 例仅接受支架治疗。PDT、RFA 和单纯支架组的总生存率分别为 11.9%（95%CI：10.7-13.1）个月、8.1%（95%CI：6.4-9.9）个月和 6.7%（95%CI：4.9-8.4）个月。PDT、RFA 和单纯支架组的支架通畅时间分别为 6.1 个月（95%CI：4.2-8.0）、5.5 个月（95%CI：4.2-6.7）和 4.7 个月（95%CI：2.6-6.7）。PDT 的 30 天死亡率为 3.3%（95%CI：1.6%-6.7%），RFA 为 7%（95%CI：4.1%-11.7%），单纯支架为 4.9%（95%CI：1.7%-13.1%）。PDT 的 90 天死亡率为 10.4%（95%CI：5.4%-19.2%），RFA 为 16.3%（95%CI：8.7%-28.6%）。
与单纯支架姑息治疗相比，PDT 似乎显示出更好的总生存率和 30 天死亡率。
