内镜射频消融术与光动力疗法治疗不可切除肝外胆管癌远期疗效的对比研究

Long-term efficacy study of endoscopic radiofrequency ablation and photodynamic therapy for unresectable extrahepatic cholangiocarcinoma

摘要:

目的 比较内镜射频消融术（RFA）与光动力疗法（PDT）联合胆道支架置入治疗不可切除肝外胆管癌的远期疗效。方法 回顾性分析2018年2月－2023年2月于该院接受内镜RFA或PDT治疗的胆管癌患者的临床资料，根据手术方法不同，将患者分为RFA组（n = 32，行内镜RFA联合胆道支架置入）和PDT组（n = 21，行内镜PDT联合胆道支架置入）。比较两组患者治疗次数、支架通畅期、总体生存期和并发症发生率，并分析影响患者生存期的危险因素。结果 RFA组与PDT组总体生存期分别为14.0（95%CI：11.8～16.2）和18.0（95%CI：15.4～20.6）个月，支架中位通畅期分别为4.0（95%CI：2.7～5.3）和3.5（95%CI：2.3～4.7）个月，差异均无统计学意义（P > 0.05）；多因素Cox回归分析显示，内镜下RFA或PDT治疗次数的HR＾ = 2.417，≥ 2次是影响总体生存期的保护性因素（P = 0.018），而TNM分期的HR＾ = 0.300，Ⅲ期至Ⅳ期是影响总体生存期的危险性因素（P = 0.002）；两组患者临床成功率均为100.00%；两组患者并发症总发生率［28.13%（9/32）和23.81%（5/21）］比较，差异无统计学意义（P > 0.05）。结论 内镜RFA与PDT联合胆道支架置入，治疗不可切除肝外胆管癌的远期疗效相似。内镜RFA或PDT序贯治疗 ≥ 2次，能够有效地延长患者的总体生存期。

Abstract:

Objective To evaluate and compare the long-term efficacy of endoscopic radiofrequency ablation (RFA) and photodynamic therapy (PDT) combined with biliary stenting for the treatment of unresectable extrahepatic cholangiocarcinoma.Methods Clinical data of patients with cholangiocarcinoma who received endoscopic RFA or PDT treatment from February 2018 to February 2023 were retrospectively collected. The patients were divided into RFA group (n = 30, received endoscopic RFA combined with biliary stent placement) and PDT group (n = 20, received PDT combined with biliary stent placement). The frequency of treatment, stent patency time, overall survival time and adverse events incidence were counted. The factors affecting the survival time of patients were analyzed.Results The overall survival time was 14.0 (95%CI: 11.8 ~ 16.2) months in RFA group and 18.0 (95%CI: 15.4~20.6) months in PDT group, the median patency time of stent was 4.0 (95%CI:2.7 ~ 5.3) months in RFA group and 3.5 (95%CI:2.3 ~ 4.7) months in PDT group, the differences were not statistically significant (P > 0.05). Multivariate Cox regression analysis showed that the HR＾ of patients with ≥ 2 endoscopic RFA or PDT treatments was 2.417, which was a protective factor affecting overall survival (P = 0.018), while the HR＾ of TNM stage Ⅲ to Ⅳ was 0.300, which was a risk factor affecting the overall survival period (P = 0.002). No significant difference was found in clinical success rate (both 100.00%) and adverse events incidence between the two groups [28.13% (9/32) vs. 23.81% (5/21)], the difference was not statistically significant (P > 0.05).Conclusion The long-term efficacy of endoscopic RFA or PDT combined with biliary stenting in the treatment of unresectable extrahepatic cholangiocarcinoma is comparable, while the sequential treatment of endoscopic RFA or PDT ≥2 times can effectively prolong the overall survival of patients.