Matsunaga Yutaro, Higuchi Ryota, Yazawa Takehisa, Uemura Shuichiro, Izumo Wataru, Ota Takehiro, Furukawa Toru, Yamamoto Masakazu
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Department of Investigative Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai, 980-8575, Japan.
Int J Clin Oncol. 2021 Aug;26(8):1492-1499. doi: 10.1007/s10147-021-01926-8. Epub 2021 Apr 26.
The efficacy of different types of preoperative biliary drainage for cholangiocarcinoma has been debated over the past two decades. Controversy concerning the use of percutaneous transhepatic biliary drainage (PTBD) versus endoscopic biliary drainage (EBD) still exists. This study aimed to compare the long-term outcomes between PTBD and EBD in patients with distal cholangiocarcinoma.
Data of patients diagnosed with distal cholangiocarcinoma who underwent preoperative PTBD or EBD from January 1999 to December 2017 were analyzed retrospectively. Post-surgical outcomes, including the incidence of post-operative complications, peritoneal metastasis, disease-free survival, and overall survival, were analyzed. Survival analyses were also performed after propensity score matching in the PTBD and EBD groups.
The incidence of post-operative complications was similar in both groups. The 5-year estimated cumulative incidences for peritoneal metastasis were 14.7% and 7.2% in the PTBD and EBD groups, respectively (p = 0.192). The 5-year disease-free survival rates were 23.7% and 47.3% in the PTBD and EBD groups, respectively (p = 0.015). In the multi-variate analysis for overall survival, PTBD was an independent poor prognostic factor. The 5-year overall survival rates were 35.9% and 56.3% in the PTBD and EBD groups, respectively (hazard ratio 1.85, confidence interval 1.05-3.26, p = 0.035). The results after propensity score matching indicated a poorer prognosis in the PTBD group, with a 5-year survival rate of 35.9% in the PTBD group vs 56.0% in the EBD group (p = 0.044).
PTBD should be considered as a negative prognostic factor in distal cholangiocarcinoma patients.
在过去二十年中，不同类型的术前胆道引流治疗胆管癌的疗效一直存在争议。关于经皮经肝胆道引流（PTBD）与内镜下胆道引流（EBD）的使用仍存在争议。本研究旨在比较远端胆管癌患者PTBD和EBD的长期疗效。
回顾性分析1999年1月至2017年12月期间接受术前PTBD或EBD的远端胆管癌患者的数据。分析术后结果，包括术后并发症发生率、腹膜转移、无病生存期和总生存期。还对PTBD组和EBD组进行倾向评分匹配后的生存分析。
两组术后并发症发生率相似。PTBD组和EBD组腹膜转移的5年估计累积发生率分别为14.7%和7.2%（p = 0.192）。PTBD组和EBD组的5年无病生存率分别为23.7%和47.3%（p = 0.015）。在总生存期的多变量分析中，PTBD是一个独立的不良预后因素。PTBD组和EBD组的5年总生存率分别为35.9%和56.3%（风险比1.85，置信区间1.05 - 3.26，p = 0.035）。倾向评分匹配后的结果表明PTBD组预后较差，PTBD组5年生存率为35.9%，EBD组为56.0%（p = 0.044）。
PTBD应被视为远端胆管癌患者的不良预后因素。
