Mao Xiaonan, Wen Feng, Liang Hongyuan, Sun Wei, Lu Zaiming
Department of Radiology, Shengjing Hospital of China Medical University, Huaxiang Road 39, Shenyang City, 110004, Liaoning Province, China.
Support Care Cancer. 2021 Nov;29(11):6781-6792. doi: 10.1007/s00520-021-06271-0. Epub 2021 May 14.
The purpose of this study is to investigate the influencing factors that may impact the clinical success, jaundice-free time, and overall survival in patients of malignant hilar biliary obstruction (MHBO) treated with a self-expanding metallic stent (SEMS).
Patients diagnosed with MHBO and treated with SEMS through percutaneous access from 1 Jul. 2013 to 1 Jul. 2018 were enrolled in this monocentric study. Demographic information, disease baseline measurements, and interventional strategies were collected and examined. Bilirubin was measured 1-3 days before and 3-7 days after stenting using the unit of "μmol/L." The bilirubin reduction ratio was compared between different study groups, which were separated by specific characteristics. Univariate and multivariate analyses were performed to evaluate each characteristic's impact on jaundice-free time (JF) and overall survival time (OS). Statistical analyses were conducted using SPSS 14.0, p < 0.05 indicated significance.
Eighty patients were enrolled. Direct bilirubin (DB) and indirect bilirubin (IB) both significantly decreased after stenting (U = 1575.0, p < 0.001; U = 1541.0, p < 0.001). The DB reduction ratio of the "nearby lymph metastases" group was significantly higher (U = 566.0, p = 0.037). The IB reduction ratio in the "single stent" group was significantly higher (U = 554.0, p = 0.018). Sixty-six cases reached jaundice recurrence, the median JF was 6 months, and the 95% confidence interval was 4.411 ~ 7.589 months. Fifty-eight cases ended in death, the median OS was 7 months, and the 95% confidence interval was 5.759 ~ 8.241 months. "Nearby lymph metastases" and "distant metastases" independently impacted OS (OR = 2.344, p = 0.013; OR = 3.239, p = 0.042). "IB reduction ratio" independently impacted both JF and OS (OR = 0.422, p = 0.021; OR = 0.315, p = 0.001).
The goal of treatment in patients with MHBO is to recover liver function. However, the overall survival is greatly impacted by the presence of metastases. Managing to obtain adequate liver function recovery may improve the long-term outcomes in affected patients.
本研究旨在探讨可能影响经自膨式金属支架（SEMS）治疗的恶性肝门部胆管梗阻（MHBO）患者临床成功率、无黄疸时间及总生存期的影响因素。
本单中心研究纳入了2013年7月1日至2018年7月1日期间经皮穿刺诊断为MHBO并接受SEMS治疗的患者。收集并检查人口统计学信息、疾病基线测量值及介入策略。在支架置入前1 - 3天和置入后3 - 7天以“μmol/L”为单位测量胆红素。比较不同研究组（按特定特征划分）之间的胆红素降低率。进行单因素和多因素分析以评估各特征对无黄疸时间（JF）和总生存时间（OS）的影响。使用SPSS 14.0进行统计分析，p < 0.05表示有统计学意义。
共纳入80例患者。支架置入后直接胆红素（DB）和间接胆红素（IB）均显著降低（U = 1575.0，p < 0.001；U = 1541.0，p < 0.001）。“附近淋巴结转移”组的DB降低率显著更高（U = 566.0，p = 0.037）。“单支架”组的IB降低率显著更高（U = 554.0，p = 0.018）。66例出现黄疸复发，中位JF为6个月，95%置信区间为4.411至7.589个月。58例死亡，中位OS为7个月，95%置信区间为5.759至8.241个月。“附近淋巴结转移”和“远处转移”独立影响OS（OR = 2.344，p = 0.013；OR = 3.239，p = 0.042）。“IB降低率”独立影响JF和OS（OR = 0.422，p = 0.021；OR = 0.315，p = 0.001）。
MHBO患者的治疗目标是恢复肝功能。然而，转移的存在对总生存期有很大影响。设法实现足够的肝功能恢复可能改善受影响患者的长期预后。
