Chen Hanhan, Li Honglin, Li Huijie, Zhang Zhen
Department of Breast and Thyroid Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
Traditional Chinese Medicine, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China.
Photodiagnosis Photodyn Ther. 2025 Feb;51:104472. doi: 10.1016/j.pdpdt.2025.104472. Epub 2025 Jan 4.
Cholangiocarcinoma is a rare and often fatal malignancy. Numerous studies have demonstrated promising outcomes and survival rates associated with adjuvant photodynamic therapy (PDT) in the palliative treatment of cholangiocarcinoma.
To systematically evaluate the existing meta-analyses on PDT for cholangiocarcinoma, assessing evidence quality and strength while performing updated meta-analyses to refine survival outcomes.
PubMed, EMBASE, Cochrane Library, and Web of Science were systematically searched up to September 18, 2024, to identify meta-analyses and clinical studies on PDT in patients with cholangiocarcinoma. The random-effects model was employed to re-synthesize existing meta-analyses, with a comprehensive evaluation of methodological quality. Updated meta-analyses of survival data were conducted, including subgroup analyses stratified by cholangiocarcinoma type and intervention modality.
A total of 5 meta-analyses and 21 clinical studies were included. The findings indicated that combining PDT with stenting or chemotherapy can significantly improve overall survival in patients with cholangiocarcinoma and reduce mortality rate, without increasing the risk of adverse events (AEs) such as cholangitis or abscess formation. For extrahepatic cholangiocarcinoma, adding PDT to stenting demonstrated a notable improvement in the 2-year survival rate. Meanwhile, for hilar cholangiocarcinoma, the addition of chemotherapy to PDT showed a more pronounced enhancement in the 1-year survival rate.
Current evidence indicates that PDT combined with stenting or chemotherapy in the palliative treatment of cholangiocarcinoma decreases overall mortality and enhances OS without increasing the incidence of AEs. Adding PDT to stenting or chemotherapy may be more beneficial for long-term efficacy.
胆管癌是一种罕见且往往致命的恶性肿瘤。大量研究表明，辅助光动力疗法（PDT）在胆管癌的姑息治疗中具有良好的疗效和生存率。
系统评价现有的关于胆管癌光动力疗法的荟萃分析，评估证据质量和强度，并进行更新的荟萃分析以优化生存结果。
截至2024年9月18日，系统检索PubMed、EMBASE、Cochrane图书馆和Web of Science，以识别关于胆管癌患者光动力疗法的荟萃分析和临床研究。采用随机效应模型重新综合现有的荟萃分析，并对方法学质量进行全面评估。对生存数据进行更新的荟萃分析，包括按胆管癌类型和干预方式分层的亚组分析。
共纳入5项荟萃分析和21项临床研究。结果表明，光动力疗法联合支架置入或化疗可显著提高胆管癌患者的总生存率，降低死亡率，且不增加胆管炎或脓肿形成等不良事件（AE）的风险。对于肝外胆管癌，在支架置入中加入光动力疗法可显著提高2年生存率。同时，对于肝门部胆管癌，在光动力疗法中加入化疗可更显著地提高1年生存率。
目前的证据表明，光动力疗法联合支架置入或化疗在胆管癌的姑息治疗中可降低总死亡率，提高总生存率，且不增加不良事件的发生率。在支架置入或化疗中加入光动力疗法可能对长期疗效更有益。
