Comparison of the efficacy between stent combined with 125I seeds intracavitary irradiation and palliative surgery in advanced extrahepatic cholangiocarcinoma

doi:10.3877/cma.j.issn.1674-0793.2021.06.003

Abstract

Abstract:

Objective

To explore and compare the clinical application of biliary stent combined with ¹²⁵I seeds implantation and palliative surgery (PS) in patients with advanced extrahepatic cholangiocarcinoma (EHCC).

Methods

136 advanced EHCC patients, who were admitted into Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College and received medical treatment between January 2014 and December 2019, were analyzed retrospectively. According to the treatment method, the patients were divided into two groups: combination group (received biliary stent combined with ¹²⁵I seeds implantation, 91 cases) and PS group (underwent open choledochojejunostomy and cholecystectomy, 45 cases). The levels of serum bilirubin, aminotransferase and albumin (ALB) were observed at 1, 3 and 6 months postoperatively in the two groups. The length of stay, hospital costs, and postoperative overall complications were compared between the two groups. Kaplan-Meier curves were used to analyze the differences in overall survival (OS).

Results

The serum levels of bilirubin, transaminase, and ALB at 1, 3, and 6 months postoperatively were improved in both groups, compared with preoperative values. There was no statistically significant difference in postoperative overall complications between the two groups (P=0.073). Compared with the PS group, the length of stay was significantly shorter (P<0.001), hospital costs were significantly less (P<0.001), OS was significantly better in the combination group (P=0.017). The subgroup analysis further suggested that the advantage of combined therapy was more obvious in patients with hilar cholangiocarcinoma than that in distal cholangiocarcinoma. PS treatment (HR=2.665, 95% CI: 1.544-4.564, P<0.001), higher preoperative level of carbohydrate antigen 19-9 (HR=2.031, 95% CI: 1.201-3.432, P=0.008) and lower level of ALB (HR=1.908, 95% CI: 1.130-3.221, P=0.016) were independent predictors of worse OS.

Conclusions

Compared with PS, biliary stent combined with ¹²⁵I seeds implantation may significantly shorten the length of stay, reduce hospital costs, and prolong survival, without increasing the overall complications in advanced EHCC patients, which is worthy of further popularization and application in clinical practice.

Key words: Bile duct neoplasms, Brachytherapy, Stents, Palliative surgery, Overall survival

Zhiyong Mei, Qing Pang, Yong Wang, Zhongran Man, Hao Jin, Huichun Liu. Comparison of the efficacy between stent combined with ¹²⁵I seeds intracavitary irradiation and palliative surgery in advanced extrahepatic cholangiocarcinoma[J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(06): 412-417.

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Figures/Tables 6

References 18

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项目	总体	联合组	PS组	Z/χ²值	P值
例数	136	91	45
性别(例,男/女)	102/34	66/25	36/9	0.897^a	0.344
年龄(例, ≥70岁/<70岁)	78/58	55/36	23/22	1.071^a	0.301
肿瘤部位(例, HCCA/DCCA)	47/89	36/55	11/34	3.042^a	0.081
CA19-9(μg/L)	283.6(58.6~855.5)	332.1(72.5~1 006.9)	127.4(31.3~471.3)	-0.956	0.339
ALT(U/L)	102.0(68.3~215.5)	113.0(80.0~211.0)	90.0(56.5~256.0)	-1.707	0.088
AST(U/L)	116.0(69.3~161.0)	124.0(72.0~162.0)	105.0(60.0~160.0)	-0.753	0.452
TBIL(µmol/L)	184.3(117.2~300.3)	230.4(124.7~307.5)	154.6(80.9~271.4)	-0.451	0.652
DBIL(µmol/L)	156.4(93.7~253.8)	172.2(107.0~282.6)	135.3(71.1~218.1)	-0.675	0.500
ALB(g/L)	34.4(31.5~37.8)	33.8(31.1~37.5)	35.1(31.8~38.0)	-1.233	0.217

项目	总体	联合组	PS组	Z/χ²值	P值
例数	136	91	45
性别(例,男/女)	102/34	66/25	36/9	0.897^a	0.344
年龄(例, ≥70岁/<70岁)	78/58	55/36	23/22	1.071^a	0.301
肿瘤部位(例, HCCA/DCCA)	47/89	36/55	11/34	3.042^a	0.081
CA19-9(μg/L)	283.6(58.6~855.5)	332.1(72.5~1 006.9)	127.4(31.3~471.3)	-0.956	0.339
ALT(U/L)	102.0(68.3~215.5)	113.0(80.0~211.0)	90.0(56.5~256.0)	-1.707	0.088
AST(U/L)	116.0(69.3~161.0)	124.0(72.0~162.0)	105.0(60.0~160.0)	-0.753	0.452
TBIL(µmol/L)	184.3(117.2~300.3)	230.4(124.7~307.5)	154.6(80.9~271.4)	-0.451	0.652
DBIL(µmol/L)	156.4(93.7~253.8)	172.2(107.0~282.6)	135.3(71.1~218.1)	-0.675	0.500
ALB(g/L)	34.4(31.5~37.8)	33.8(31.1~37.5)	35.1(31.8~38.0)	-1.233	0.217

变量	单因素分析		多因素分析
变量	HR (95% CI)	P值	HR (95% CI)	P值
性别(男/女)	1.179(0.722~1.927)	0.510
年龄(≥70岁/<70岁)	1.195(0.780~1.829)	0.413
肿瘤部位(HCCA/DCCA)	1.232(0.792~1.918)	0.355
CA19-9 (≥283.6 /<283.6μg/L)	1.980(1.259~3.115)	0.003	2.031(1.201~3.432)	0.008
ALT (≥102.0 U/L /<102.0 U/L)	1.215(0.791~1.866)	0.374
AST (≥116.0 U/L /<116.0 U/L)	1.036(0.675~1.590)	0.872
TBIL (≥184.3µmol/L /<184.3 µmol/L)	1.690(1.105~2.584)	0.015	1.467(0.860~2.504)	0.160
ALB (≤34.4 g/L />34.4 g/L)	1.634(1.066~2.506)	0.024	1.908(1.130~3.221)	0.016
治疗方法(PS/胆道支架联合¹²⁵I粒子)	1.671(1.074~2.599)	0.023	2.665(1.544~4.564)	<0.001

变量	单因素分析		多因素分析
变量	HR (95% CI)	P值	HR (95% CI)	P值
性别(男/女)	1.179(0.722~1.927)	0.510
年龄(≥70岁/<70岁)	1.195(0.780~1.829)	0.413
肿瘤部位(HCCA/DCCA)	1.232(0.792~1.918)	0.355
CA19-9 (≥283.6 /<283.6μg/L)	1.980(1.259~3.115)	0.003	2.031(1.201~3.432)	0.008
ALT (≥102.0 U/L /<102.0 U/L)	1.215(0.791~1.866)	0.374
AST (≥116.0 U/L /<116.0 U/L)	1.036(0.675~1.590)	0.872
TBIL (≥184.3µmol/L /<184.3 µmol/L)	1.690(1.105~2.584)	0.015	1.467(0.860~2.504)	0.160
ALB (≤34.4 g/L />34.4 g/L)	1.634(1.066~2.506)	0.024	1.908(1.130~3.221)	0.016
治疗方法(PS/胆道支架联合¹²⁵I粒子)	1.671(1.074~2.599)	0.023	2.665(1.544~4.564)	<0.001

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