Comparative Effectiveness of Hepatic Artery Based Therapies for Unresectable Intrahepatic Cholangiocarcinoma
Comparative Effectiveness of Hepatic Artery Based Therapies for Unresectable Intrahepatic Cholangiocarcinoma
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DOI：
10.1002/jso.23781
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发表时间：
2015-02-01
影响因子：
2.5
通讯作者：
Gamblin, T. Clark
中科院分区：
文献类型：
--
作者：
Boehm, Lucas M.;Jayakrishnan, Thejus T.;Gamblin, T. Clark
背景：肝动脉为基础的治疗（HAT）提供了不可切除的肝内胆管癌（ICC）患者。我们的目的是评估hat -肝动脉输注（HAI）、经导管动脉化疗栓塞（TACE）、药物洗脱头TACE （DEB-TACE）和钇（90）放射栓塞（Y-90）治疗不可切除ICC的比较效果。方法：采用PROSPERO （CRD42013004830）的前瞻性注册搜索策略，利用PubMed（2003-2013）进行荟萃分析。主要结局是中位总生存期（OS），次要结局是肿瘤对治疗的反应和毒性。结果：共纳入文献20篇（共793篇，n = 657例）进行数据提取。最高中位OS观察到HAI （22.8, 95% CI 9.8-35.8）个月，Y90（13.9, 9.5-18.3）个月，TACE（12.4, 10.9-13.9）个月，debtace（12.3, 11-13.5）个月。对治疗的反应（完全和部分）最高的是HAI (56.9%, 95% CI 41.0-72.8)，而Y90（27.4%, 17.4-37.5）和TACE（17.3%, 6.8-27.8）。III/IV级毒性（每个患者事件数）最高的是HAI (0.35, 95% CI 0.22-0.48)，而TACE（0.26, 0.21-0.32）和DEB-TACE（0.32, 0.17-0.48）。结论：对于接受HAT治疗的不可切除ICC患者，在肿瘤反应和生存方面，HAI提供了最好的结果，但可能受到毒性的限制。(C) 2014 Wiley期刊公司
Background: Hepatic artery based therapies (HAT) are offered for patients with unresectable intrahepatic cholangiocarcinoma (ICC). We aimed to evaluate the comparative effectiveness of HAT-hepatic arterial infusion (HAI), transcatheter arterial chemoembolization (TACE), drug-eluting bead TACE (DEB-TACE), and Yttrium(90) radioembolization (Y-90) for unresectable ICC.Methods: A meta-analysis was performed using a prospectively registered search strategy at PROSPERO (CRD42013004830) that utilized PubMed (2003-2013). Primary outcome was median overall survival (OS), and secondary outcomes were tumor response to therapy and toxicity.Results: A total of 20 articles (of 793, n = 657 patients) were selected for data extraction. Highest Median OS was observed for HAI (22.8, 95% CI 9.8-35.8) months versus Y90 (13.9, 9.5-18.3) months versus TACE (12.4, 10.9-13.9) months versus DEB-TACE (12.3, 11-13.5) months. Response to therapy (complete and partial) was highest for HAI (56.9%, 95% CI 41.0-72.8) versus Y90 (27.4%, 17.4-37.5) versus TACE (17.3%, 6.8-27.8). The grade III/IV toxicity (Events per patient) was highest for HAI (0.35, 95% CI 0.22-0.48) versus TACE (0.26, 0.21-0.32) versus DEB-TACE (0.32, 0.17-0.48).Conclusion: For patients with unresectable ICC treated with HAT, HAI offered the best outcomes in terms of tumor response and survival but may be limited by toxicity. (C) 2014 Wiley Periodicals, Inc.