Chen Cui, Zhao Wen Chao, Xia Ming Xing, Zhu Jia Hui, Fu Ting Ting, Wu Jun, Yao Zhi Yuan, Hu Bing
Department of Gastroenterology, Eastern Hepatobiliary Surgery Hospital, Naval Military Medical University, Shanghai, China.
Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China.
J Dig Dis. 2025 Mar-Apr;26(3-4):170-178. doi: 10.1111/1751-2980.13350. Epub 2025 Jun 2.
Hilar-type intrahepatic cholangiocarcinoma (H-ICC), which originates from the large bile ducts, tends to invade the hepatic hilus and results in malignant hilar biliary obstruction (MHBO). Compared with hilar cholangiocarcinoma (HC), H-ICC exhibits a more aggressive biological behavior and a dismal prognosis. We aimed to investigate the optimal biliary stenting strategy for the treatment of unresectable H-ICC.
Patients with unresectable H-ICC who received endoscopic biliary stenting (EBS) between January 2012 and June 2019 were retrospectively included in this study. The prognostic factors of survival outcome, clinical success, duration of stent patency, and EBS-related adverse events were analyzed.
Altogether 70 patients were enrolled, including 72.9% patients with multiple intrahepatic lesions and 44.3% with lymphatic metastasis. Jaundice control was achieved in 81.4% of the patients. Early cholangitis was the main treatment-related complication (17.1%). After successful stenting, systematic antitumor therapy was the only independent factor related to overall survival (hazard ratio [HR] 0.381, 95% confidence interval [CI] 0.218-0.668, p = 0.001). Plastic stenting was associated with clinical success (odds ratio [OR] 0.012, 95% CI 0.008-0.549, p = 0.012), stent patency (HR 6.773, 95% CI 2.221-20.653, p = 0.001), and early cholangitis (OR 5.000, 95% CI 1.006-24.841, p = 0.049). Bismuth classification IV was independently related to stent patency (HR 4.956, 95% CI 1.245-19.730, p = 0.023).
For H-ICC-induced MHBO, metal stent placement may achieve better biliary drainage and, combined with systemic antitumor therapies, may further improve patient survival.
肝门部型肝内胆管癌（H-ICC）起源于大胆管，易于侵犯肝门并导致恶性肝门部胆管梗阻（MHBO）。与肝门部胆管癌（HC）相比，H-ICC表现出更具侵袭性的生物学行为和较差的预后。我们旨在研究治疗不可切除H-ICC的最佳胆管支架置入策略。
回顾性纳入2012年1月至2019年6月期间接受内镜胆管支架置入术（EBS）的不可切除H-ICC患者。分析生存结局、临床成功率、支架通畅持续时间和EBS相关不良事件的预后因素。
共纳入70例患者，其中72.9%有多发性肝内病变，44.3%有淋巴结转移。81.4%的患者黄疸得到控制。早期胆管炎是主要的治疗相关并发症（17.1%）。成功置入支架后，系统性抗肿瘤治疗是与总生存相关的唯一独立因素（风险比[HR]0.381，95%置信区间[CI]0.218-0.668，p = 0.001）。塑料支架与临床成功（比值比[OR]0.012，95%CI 0.008-0.549，p = 0.012）、支架通畅（HR 6.773，95%CI 2.221-20.653，p = 0.001）和早期胆管炎（OR 5.000，95%CI 1.006-24.841，p = 0.049）相关。Bismuth分型IV与支架通畅独立相关（HR 4.956，95%CI 1.245-19.730，p = 0.023）。
对于H-ICC引起的MHBO，金属支架置入可能实现更好的胆管引流，并且与系统性抗肿瘤治疗相结合，可能进一步提高患者生存率。
