Yu Yang, Wang Na, Wang Yingying, Shi Qianling, Yu Rong, Gu Baohong, Maswikiti Ewetse Paul, Chen Hao
The Department of Tumor Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China; The Second Clinical Medical College, Lanzhou University, Lanzhou 730030, China.
The Second Clinical Medical College, Lanzhou University, Lanzhou 730030, China.
Photodiagnosis Photodyn Ther. 2023 Mar;41:103318. doi: 10.1016/j.pdpdt.2023.103318. Epub 2023 Feb 2.
Extrahepatic cholangiocarcinoma (ECC) is a tumor with high invasiveness and poor outcome. The current treatments for unresected ECC are not ideal. Novel strategies are needed to improve the outcomes of patients with unresected ECC. Photodynamic therapy (PDT) plus chemotherapy is one of the promising interventions for ECC patients. We conducted this systematic review to determine the efficacy and safety of PDT plus chemotherapy in unresected ECC patients.
Databases of PubMed, Cochrane Library, Embase, and Web of science were searched from inception to July 2022. Studies that compared PDT plus chemotherapy to PDT alone or chemotherapy alone in patients with unresected ECC were included. Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were pooled for overall survival (OS) and adverse events, respectively.
Seven eligible studies were finally included. There are four studies on PDT plus chemotherapy vs. chemotherapy alone and three studies on PDT plus chemotherapy vs. PDT alone. The meta-analysis showed that PDT plus chemotherapy had a significantly better OS than chemotherapy or PDT alone (PDT+chemotherapy vs. chemotherapy alone, HR: 0.69, p = 0.02; PDT+chemotherapy vs. PDT alone, HR:0.36, p<0.01). The occurrence of cholangitis, abscess, and photosensitivity reaction in PDT plus chemotherapy were comparable to either chemotherapy alone or PDT alone (p>0.05).
The combination of PDT and chemotherapy can improve patient survival for unresected ECC without increased adverse events. It may be a potential standard therapy in the future management of ECC.
肝外胆管癌（ECC）是一种侵袭性高、预后差的肿瘤。目前针对不可切除ECC的治疗方法并不理想。需要新的策略来改善不可切除ECC患者的预后。光动力疗法（PDT）联合化疗是ECC患者有前景的干预措施之一。我们进行了这项系统评价，以确定PDT联合化疗在不可切除ECC患者中的疗效和安全性。
检索了PubMed、Cochrane图书馆、Embase和Web of science数据库，检索时间从建库至2022年7月。纳入比较PDT联合化疗与单纯PDT或单纯化疗在不可切除ECC患者中的研究。分别汇总总生存期（OS）和不良事件的风险比（HR）及比值比（OR），并给出95%置信区间（CI）。
最终纳入7项符合条件的研究。其中4项研究比较了PDT联合化疗与单纯化疗，3项研究比较了PDT联合化疗与单纯PDT。荟萃分析显示，PDT联合化疗的OS显著优于单纯化疗或单纯PDT（PDT联合化疗 vs. 单纯化疗，HR：0.69，p = 0.02；PDT联合化疗 vs. 单纯PDT，HR：0.36，p<0.01）。PDT联合化疗中胆管炎、脓肿和光敏反应的发生率与单纯化疗或单纯PDT相当（p>0.05）。
PDT与化疗联合可提高不可切除ECC患者的生存率，且不增加不良事件。它可能是未来ECC治疗的潜在标准疗法。
