Xu Jiajia, Chen Chao, Ye Yanhua, Ren Yanqiao, Chen Ke, Zhou Guofeng, Cheng Chuan, Peng Yuexiang
Department of Ultrasonography, Wuhan Third Hospital, Wuhan, Hubei, China.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Therap Adv Gastroenterol. 2025 Aug 22;18:17562848251360114. doi: 10.1177/17562848251360114. eCollection 2025.
Intrahepatic cholangiocarcinoma (ICC) with obstructive jaundice presents a therapeutic challenge, as most patients are ineligible for surgery. While FOLFOX chemotherapy offers limited survival benefits, drug-eluting bead transarterial chemoembolization (DEB-TACE) combined with percutaneous transhepatic cholangial drainage (PTCD) may improve outcomes by addressing both tumor burden and biliary obstruction.
To evaluate the efficacy and safety of DEB-TACE + PTCD versus DEB-TACE alone in unresectable ICC patients with obstructive jaundice.
Retrospective cohort study of 209 patients treated between January 2015 and November 2024.
A total of 209 patients with ICC and obstructive jaundice were included, with 95 patients in the DEB-TACE + PTCD group (D + P group) and 114 patients in the DEB-TACE alone group (DEB group). Tumor responses were evaluated at 3 months to assess treatment efficacy, while statistical analyses of adverse events were conducted to evaluate treatment safety. Kaplan-Meier method was utilized to generate survival curves. Cox analysis was performed to identify factors influencing prognosis.
The median progression-free survival and OS were 6 and 14 months in D + P group and 5 and 11 months in the DEB group. The 3-month objective response rate (ORR) and disease control rate (DCR) were 36.2% and 76.6% in the D + P group. While in the DEB group, the ORR and DCR were 34.2% ( = 0.772) and 62.2% ( = 0.026). Multivariate Cox regression analysis revealed that lymph node metastasis (hazard ratio (HR) = 0.727, confidence interval (CI: 0.535-0.987), = 0.041), level of cancer antigen (CA)-125 (HR = 0.670, CI (0.503-0.894), = 0.006), and treatment (HR = 1.335, CI (1.002-1.780), = 0.049) were predictors for prognosis.
For patients with unresectable cholangiocarcinoma complicated by obstructive jaundice, DEB-TACE following PTCD may be a safer and more effective treatment.
伴有梗阻性黄疸的肝内胆管癌（ICC）带来了治疗挑战，因为大多数患者不适合手术。虽然FOLFOX化疗带来的生存获益有限，但载药微球经动脉化疗栓塞术（DEB-TACE）联合经皮经肝胆管引流术（PTCD）可能通过解决肿瘤负荷和胆道梗阻来改善治疗效果。
评估DEB-TACE联合PTCD与单纯DEB-TACE治疗不可切除的伴有梗阻性黄疸的ICC患者的疗效和安全性。
对2015年1月至2024年11月期间接受治疗的209例患者进行回顾性队列研究。
共纳入209例伴有梗阻性黄疸的ICC患者，其中95例在DEB-TACE联合PTCD组（D+P组），114例在单纯DEB-TACE组（DEB组）。在3个月时评估肿瘤反应以评估治疗效果，同时对不良事件进行统计分析以评估治疗安全性。采用Kaplan-Meier法生成生存曲线。进行Cox分析以确定影响预后的因素。
D+P组的中位无进展生存期和总生存期分别为6个月和14个月，DEB组分别为5个月和11个月。D+P组的3个月客观缓解率（ORR）和疾病控制率（DCR）分别为36.2%和76.6%。而在DEB组中，ORR和DCR分别为34.2%（=0.772）和62.2%（=0.026）。多因素Cox回归分析显示，淋巴结转移（风险比（HR）=0.727，置信区间（CI：0.535-0.987），=0.041）、癌抗原（CA）-125水平（HR=0.670，CI（0.503-0.894），=0.006）和治疗方式（HR=1.335，CI（1.002-1.780），=0.049）是预后的预测因素。
对于不可切除的合并梗阻性黄疸的胆管癌患者，PTCD后行DEB-TACE可能是一种更安全有效的治疗方法。
