Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Endoscopy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Cancer Med. 2023 Apr;12(8):9506-9516. doi: 10.1002/cam4.5720. Epub 2023 Feb 20.
To explore clinical outcomes of percutaneous stent implantation using volumetric criteria for unresectable malignant hilar biliary obstruction (MHBO). Additionally, aimed to identify the predictors of patients' survival.
Seventy-two patients who were initially diagnosed with MHBO between January 2013 to December 2019 in our center were retrospectively included. Patients were stratified according to the drainage achieved ≥50%, <50% of the total liver volume. Patients were divided into two groups: Group A (≥50% drainage), and Group B (<50% drainage). The main outcomes were evaluated in terms of relief of jaundice, effective drainage rate, and survival. Related factors that affect survival were analyzed.
62.5% of the included patients reached effective biliary drainage. The successful drainage rate was significantly higher in Group B than in Group A (p < 0.001). The median overall survival (mOS) of included patients was 6.4 months. Patients who received drainage ≥50% of hepatic volume achieved longer mOS than those who received drainage <50% of hepatic volume (7.6 months vs. 3.9 months, respectively, p = 0. 011). Patients who received effective biliary drainage had longer mOS than those who received ineffective biliary drainage (10.8 months vs. 4.4 months, respectively, p < 0.001). Patients who received anticancer treatment had longer mOS than those who only received palliative therapy (8.7 months vs. 4.6 months, respectively, p = 0.014). In the multivariate analysis, KPS Score ≥ 80 (p = 0.037), ≥50% drainage achieved (p = 0.038), and effective biliary drainage (p = 0.036) were protective prognostic factors that affected patients' survival.
Drainage achieved ≥50% of the total liver volume by percutaneous transhepatic biliary stenting seemed to have a higher effective drainage rate in MHBO patients. Effective biliary drainage may create chances for these patients to receive anticancer therapies that seem to provide survival benefits.
探讨经皮支架植入术治疗不可切除性肝门部恶性胆道梗阻（MHBO）的临床疗效。此外，还旨在确定影响患者生存的预测因素。
回顾性纳入 2013 年 1 月至 2019 年 12 月在我院确诊为 MHBO 的 72 例患者。根据获得的引流是否达到总肝体积的≥50%、<50%将患者分层。将患者分为两组：A 组（≥50%引流）和 B 组（<50%引流）。主要评估指标为黄疸缓解、有效引流率和生存情况。分析影响生存的相关因素。
62.5%的患者胆道引流有效。B 组有效引流率明显高于 A 组（p<0.001）。纳入患者的中位总生存期（mOS）为 6.4 个月。接受≥50%肝体积引流的患者 mOS 明显长于接受<50%肝体积引流的患者（7.6 个月比 3.9 个月，p=0.011）。接受有效胆道引流的患者 mOS 明显长于接受无效胆道引流的患者（10.8 个月比 4.4 个月，p<0.001）。接受抗癌治疗的患者 mOS 明显长于仅接受姑息治疗的患者（8.7 个月比 4.6 个月，p=0.014）。多因素分析显示，KPS 评分≥80（p=0.037）、达到≥50%引流（p=0.038）和有效胆道引流（p=0.036）是影响患者生存的保护预后因素。
经皮经肝胆道支架置入术达到总肝体积的≥50%似乎能提高 MHBO 患者的有效引流率。有效的胆道引流可能为这些患者提供接受抗癌治疗的机会，从而带来生存获益。
