Zhang Yi, Zhang Ze, Yin Xiaoxv, Xu Anhui, Hao Yonghong, Jiang Nan, Zhou Ruibing, Mu Ketao
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Eur Radiol. 2025 Apr 11. doi: 10.1007/s00330-025-11557-6.
Patients with unresectable intrahepatic cholangiocarcinoma (ICC) have poor overall survival (OS). Hepatic arterial infusion chemotherapy (HAIC) and transarterial chemoembolization (TACE), including conventional TACE (c-TACE) and drug-eluting bead TACE (DEB-TACE), are widely used to treat ICC, but the efficacy of these therapies has not been fully demonstrated. This study aimed to compare the efficacy of HAIC and TACE in unresectable ICC patients.
This retrospective cohort study included unresectable ICC patients who received HAIC, c-TACE or DEB-TACE as initial treatment between June 2016 and October 2023 at three hospitals. The median OS (mOS), tumor response, and incidence of adverse events (AEs) were compared and propensity score matching (PSM) was used to reduce selection bias.
A total of 181 patients with unresectable ICC received HAIC (n = 24), c-TACE (n = 73) and DEB-TACE (n = 84). The HAIC group had significantly higher mOS (10.3 vs. 5.1 months, p = 0.0042), objective response rate (ORR) (29.2% vs. 4.1%, p = 0.002) and disease control rate (DCR) (95.8% vs. 43.8%, p < 0.001) than the c-TACE group. There was no significant difference between the HAIC and DEB-TACE groups in improving mOS (10.3 vs. 12.5 months, p = 0.61). Results remained consistent after PSM. The c-TACE and DEB-TACE groups had a higher incidence of AEs compared with the HAIC group. After matching, there was no significant difference in the incidence of AEs between groups.
HAIC improves ICC patient prognosis better than c-TACE. Both HAIC and DEB-TACE are superior treatment options for unresectable ICC.
Question The evidence of comparative effectiveness between hepatic arterial infusion chemotherapy (HAIC) and transarterial chemoembolization (TACE) is insufficient. Findings HAIC significantly improved median overall survival, tumor response, and prognosis while reducing adverse events compared to convention TACE (c-TACE) in unresectable intrahepatic cholangiocarcinoma (ICC) patients. Clinical relevance HAIC significantly improves OS and tumor response in patients with unresectable ICC compared to c-TACE, but HAIC shows no significant difference from drug-eluting bead-TACE. Notably, HAIC shows no significant difference in adverse events compared to both c-TACE and DEB-TACE.
无法切除的肝内胆管癌（ICC）患者的总生存期（OS）较差。肝动脉灌注化疗（HAIC）和经动脉化疗栓塞（TACE），包括传统TACE（c-TACE）和载药微球TACE（DEB-TACE），被广泛用于治疗ICC，但这些疗法的疗效尚未得到充分证实。本研究旨在比较HAIC和TACE在无法切除的ICC患者中的疗效。
这项回顾性队列研究纳入了2016年6月至2023年10月期间在三家医院接受HAIC、c-TACE或DEB-TACE作为初始治疗的无法切除的ICC患者。比较了中位OS（mOS）、肿瘤反应和不良事件（AE）的发生率，并采用倾向评分匹配（PSM）来减少选择偏倚。
共有181例无法切除的ICC患者接受了HAIC（n = 24）、c-TACE（n = 73）和DEB-TACE（n = 84）治疗。HAIC组的mOS（10.3个月对5.1个月，p = 0.0042）、客观缓解率（ORR）（29.2%对4.1%，p = 0.002）和疾病控制率（DCR）（95.8%对43.8%，p < 0.001）均显著高于c-TACE组。HAIC组和DEB-TACE组在改善mOS方面无显著差异（10.3个月对12.5个月，p = 0.61）。PSM后结果仍然一致。与HAIC组相比，c-TACE组和DEB-TACE组的AE发生率更高。匹配后，各组之间的AE发生率无显著差异。
HAIC比c-TACE能更好地改善ICC患者的预后。HAIC和DEB-TACE都是无法切除的ICC的优越治疗选择。
问题 肝动脉灌注化疗（HAIC）和经动脉化疗栓塞（TACE）之间的比较有效性证据不足。研究结果 在无法切除的肝内胆管癌（ICC）患者中，与传统TACE（c-TACE）相比，HAIC显著改善了中位总生存期、肿瘤反应和预后，同时减少了不良事件。临床意义 与c-TACE相比，HAIC显著改善了无法切除的ICC患者的OS和肿瘤反应，但HAIC与载药微球TACE无显著差异。值得注意的是，与c-TACE和DEB-TACE相比，HAIC在不良事件方面无显著差异。
