The Effect Of Photodynamic Therapy Or Endobiliary Radiofrequency Ablation Combined With Metal Stent Placement On Unresectable Cholangiocarcinoma

Research background and ObjectiveCholangiocarcinoma is one of the most common malignant biliary tumor,with lower diagnosis rate in early stage.It’s mostly diagnosed as an advanced stage,with low resectable rate and poor prognosis.Therefore,it’s necessary to improve the survival time and life quality of patients with advanced-stage cholangiocarcinoma.The purpose of this present research is to analyze retrospectively and compare the curative effects of patients with unresectable extrahepatic cholangiocarcinoma(CCA)treated by the placement of self-expanding metal stents(SEMS)combined with endobiliary radiofrequency ablation(ERFA),or photodynamic therapy(PDT)plus SEMS,or SEMS only.Method79 cases of patents clincal data were collected,who diagnosed as unresectable cholangiocarcinoma(34 patients with type I hilar cholangiocarcinoma,45 patients with distal cholangiocarcinoma)in our hospital from January,2015 to October,2016.Of which 20 patents underwent PDT with SEMS(PDT+SEMS group),29 patents underwent ERFA with SEMS(ERFA+SEMS group),30 patents underwent SEMS only(SEMS group).ResultThe median survival time in PDT+SEMS group,in ERFA+SEMS group and in SEMS group were respectively 8.6 months(range 5.4 months to 17.4 months),9.7 months(range 4.0 months to 16.7 months)and 6.8 months(range 2.9 months to 13.3 months).There was no significant difference in survival time between PDT+SEMS group and ERFA+SEMS group(log-rank test,p=0.683);while there was significant difference in survival time between PDT+SEMS group and SEMS+SEMS group(log-rank test,p=0.013);Meanwhile there was significant difference in survival time between ERFA+SEMS group and SEMS group(log-rank test,p=0.001).The median stent patency in PDT+SEMS group,in ERFA+SEMS group and in SEMS group were respectively 8.5 months(range 3.3 months to 13.3 months),7.8 months(range 4.3 months to 11.3 months)and 4.8 months(range 2.0 months to 10.0 months).There was no significant difference in stent patency between PDT+SEMS group and ERFA+SEMS group(Mann-Whitney U test,p=0.28),while there was significant difference in stent patency between PDT+SEMS group and SEMS group(Mann-Whitney U test,p<0.001),Meanwhile there was significant difference in stent patency time between ERFA+SEMS group and SEMS group(p<0.001).It was showed by Multivariate Cox proportional hazards regression analyses that the treatment method,preoperative GGT level,TNM stage and adjuvant chemotherapy were prognostic factors for overall survival.Conclusion 1.From the aspect of the overall survival,PDT combined with SEMS or ERFA combined with SEMS can improve patients’ survival time obviously compared with the placement of SEMS only,which difference is statistically significant.There is no significant difference in survival time between PDT and ERFA.2.From the aspect of stent patency,PDT combined with SEMS or ERFA combined with SEMS can prolong stent patency time obviously compared with the placement of SEMS only.There is no significant difference in stent patency time between PDT and ERFA.3.From the aspect of postoperative complication,the symptom appearance rate of postoperative pain,infection of biliary tract and Asymptomatic pancreatitis are similar undertaking the above 3 treatments.4.From the aspect of patients’ prognosis,the treatment method,preoperative GGT level,TNM stage,adjuvant chemotherapy are independent prognostic factors which affect patients’ survival time who sufferring from advanced-stage extrahepatic cholangiocarcinoma.Patients treated by SEMS only,high GGT level,TNM Ⅳ,no chemotherapy have higher mortality risk.