Clinical Study Of Photodynamic Therapy Combined With Stent Implantation In The Treatment Of Unresectable Extrahepatic Cholangiocarcinoma

Background & Objective:Photodynamic Therapy(PDT)can be used as a palliative treatment option for cholangiocarcinoma,but there is not enough evidence to prove its efficacy.Studies have proven that PDT is associated with survival in patients with advanced unresectable extrahepatic cholangiocarcinoma(ECC).However,the clinical utilization rate of PDT is not high.The objective of this study was to investigate the clinical efficacy and safety of PDT combined with stenting in the treatment of unresectable external hepatic cholangiocarcinoma.Methods: We retrospectively analyzed the data of 59 patients with unresectable extrahepatic bile duct carcinoma who received PDT combined with stent drainage and stent drainage alone.20 patients received PDT treatment,of which 12 were ERCPmediated PDT and 8 were PTCS-mediated PDT.39 patients were treated with stent drainage alone,of which 29 were treated with ERCP and 10 with PTCS.The median survival time and the incidence of postoperative complications were compared between the two groups.Results:1.After 68 months of follow-up,the median survival time in the PDT+ stent group was significantly longer than that in the stent drainage group alone(15.7vs7.8 months,P=0.032).2.The results of univariate COX cox proportional-hazards model showed that preoperative CA-199,preoperative TBIL and TNM staging were related to the operation method and overall survival;Multivariate COX risk proportional model showed PDT(HR=0.441 [95%CI(0.228,0.852)]),preoperative serum total bilirubin(HR=1.004[95%CI(1.001,1.007)])and preoperative CA199(HR=1.319 [95%CI(1.147,1.517)])are independent prognostic factors affecting the survival of patients with unresectable extrahepatic bile duct carcinoma.3.There was no significant difference in the incidence of postoperative adverse events between the two groups(7[35.00%]vs15[38.46%],P=0.546).Conclusion:1.In patients with unresectable advanced extrahepatic cholangiocarcinoma,photodynamic therapy combined with stent drainage has a significant advantage in improving the median survival time of patients compared with stent drainage alone.2.PDT,preoperative CA199 and preoperative serum bilirubin levels were independent factors affecting the survival of patients with advanced unresectable extrahepatic bile duct carcinoma.3.The incidence of postoperative complications was similar,indicating that the safety of photodynamic therapy was similar to that of stent drainage.