Statistical analysis of photodynamic therapy and stent drainage for unresectable cholangiocarcinoma

摘要

Background: Photodynamic therapy (PDT) combined with biliary stent showed therapeutic effects in the palliative treatment of unresectable cholangiocarcinoma (CC). We aimed to evaluate the survival outcomes and procedure-related complications of PDT compared to conventional stenting for CC patients.Methods: Databases including PubMed, Medline, Embase and Cochrane Central Database were systematically searched from inception to December 2017 for clinical trials that compared photodynamic therapy with biliary stenting. Mortality, survival period, serum bilirubin levels, successful biliary drainage rate and incidence of cholangitis were pooled analysis. The relative risk and odds ratio for dichotomous outcomes and mean difference for continuous outcomes were calculated using random-effects model. Heterogeneity was quantified using I-2 statistics. The publication bias was ascertained by visual examination of funnel plots.Results: Overall, 8 studies met inclusion criteria were included for pooling (n = 509). The PDT group had lower mortality (RR = 0.91, 95% CI:0.83-1.01, p = 0.07) and longer survival periods (MD = 202.75, 95% CI: 128.64-276.86, p 0.00001) at follow-up compared with the biliary stenting group. There were no differences in serum bilirubin (MD = 1.19, 95% CI: 3.20 0.82, p = 0.25) and the incidence of cholangitis (OR = 1.09, 95% Cl: 0.63-1.86, p = 0.77) between the two groups, whereas the PDT group showed a higher successful biliary drainage rate (OR = 4.08, 95% Cl: 2.32-7.18, p 0.00001).Conclusion: PDT is effective and has significant survival benefits for unresectable CC patients compared with stenting only. PDT could be a promising palliative treatment for patients diagnosed with advanced CC. (C) 2018 Elsevier B.V. All rights reserved.