Division of Interventional Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Cardiovasc Intervent Radiol. 2024 Oct;47(10):1313-1324. doi: 10.1007/s00270-024-03825-7. Epub 2024 Aug 26.
Transarterial radioembolization (TARE) has emerged as a promising therapeutic approach for unresectable intrahepatic cholangiocarcinoma (ICCA). We updated our previous meta-analysis with meta-regression to explore the efficacy of TARE in the context of ICCA.
We searched PubMed and Scopus for studies published up to September 1, 2023. The primary outcome was overall survival. Secondary outcomes were tumor overall response rate, severe adverse events, and downstaging to surgery. Meta-analysis employed a random-effects model, and meta-regression was utilized to explore sources of heterogeneity.
We included 27 studies, involving 1365 patients. Pooled survival estimates at 1, 2, and 3 years were 52.6%, 27%, and 16.8%, respectively. Meta-regression revealed that the proportion of patients naïve to treatment was the only pre-TARE predictor of survival (1-, 2-, and 3-year survival of 70%, 45%, and 36% for treatment-naïve patients, mean survival 19.7 months vs. 44%, 18%, and 7% for non-naïve patients, mean survival 12.2 months). Overall response according to RECIST 1.1 and mRECIST was 19.6% and 67%, respectively. Effective downstaging to surgery was possible in varying rates (3-54%); the mean survival in these patients was 34.8 months (1-, 2-, and 3-year survival of 100%, 87%, and 64%). About 45.7% of patients experienced adverse events, but only 5.9% were severe.
Our study benchmarked the survival rates of patients undergoing TARE for unresectable ICCA and showed that this is a valid option in these patients, especially if naïve to previous treatments. Downstaging to surgery is feasible in selected patients with promising results.
经动脉放射性栓塞术（TARE）已成为不可切除的肝内胆管癌（ICC）的一种有前途的治疗方法。我们使用荟萃回归更新了之前的荟萃分析，以探讨 TARE 在 ICC 中的疗效。
我们在 PubMed 和 Scopus 上搜索了截至 2023 年 9 月 1 日发表的研究。主要结果是总生存期。次要结果是肿瘤总体缓解率、严重不良事件和降期至手术。荟萃分析采用随机效应模型，荟萃回归用于探索异质性的来源。
我们纳入了 27 项研究，共 1365 名患者。1、2 和 3 年的总生存率分别为 52.6%、27%和 16.8%。荟萃回归显示，治疗前的患者无治疗史是唯一的生存预测因素（无治疗史患者的 1、2 和 3 年生存率分别为 70%、45%和 36%，平均生存时间为 19.7 个月，而非无治疗史患者的 44%、18%和 7%，平均生存时间为 12.2 个月）。根据 RECIST 1.1 和 mRECIST 的总体缓解率分别为 19.6%和 67%。手术降期的有效率（3-54%）各不相同；这些患者的平均生存时间为 34.8 个月（1、2 和 3 年的生存率为 100%、87%和 64%）。约 45.7%的患者发生不良反应，但只有 5.9%为严重不良反应。
我们的研究为接受 TARE 治疗不可切除 ICC 患者的生存率提供了基准，并表明对于这些患者来说，这是一种有效的治疗选择，特别是对于之前未接受过治疗的患者。在选定的患者中，手术降期是可行的，且结果有一定的前景。
