• Biliary malignancy
• Biliary stenosis
• Metal stent
• Percutaneous transhepatic biliary drainage
• Prognostic factors
• Scoring system

• Humans
• Cholangiocarcinoma/mortality
• Cholangiocarcinoma/therapy
• Cholangiocarcinoma/pathology
• Male
• Female
• Drainage/methods
• Middle Aged
• Aged
• Bile Duct Neoplasms/mortality
• Bile Duct Neoplasms/therapy
• Bile Duct Neoplasms/pathology
• Prognosis
• Retrospective Studies
• Bilirubin/blood
• Risk Factors
• Adult
• Aged, 80 and over

• NU21-08-00561 Ministerstvo Zdravotnictví Ceské Republiky
• NU21-08-00561 Ministerstvo Zdravotnictví Ceské Republiky
• NU21-08-00561 Ministerstvo Zdravotnictví Ceské Republiky
• NU21-08-00561 Ministerstvo Zdravotnictví Ceské Republiky
• MUNI/A/1611/2023 Ministerstvo Školství, Mládeže a Tělovýchovy
• MUNI/A/1611/2023 Ministerstvo Školství, Mládeže a Tělovýchovy
• MUNI/A/1611/2023 Ministerstvo Školství, Mládeže a Tělovýchovy
• MUNI/A/1558/2023 Ministerstvo Školství, Mládeže a Tělovýchovy
• MUNI/A/1611/2023 Ministerstvo Školství, Mládeže a Tělovýchovy
• MUNI/A/1611/2023 Ministerstvo Školství, Mládeže a Tělovýchovy

• endoscopic
• hilar
• percutaneous
• stent

• neutrophil-lymphocyte ratio
• percutaneous transhepatic biliary drainage
• total leucocyte count
• treatment response

• biliary obstruction
• drainage
• interventional radiology
• oncology
• palliative

Endoscopic drainage is the primary treatment for unresectable malignant biliary obstruction (MBO). This study developed and validated a pre-endoscopic predictive score for clinical success after stent placement.

Patients with unresectable MBO undergoing ERCP-guided endobiliary stent placement between 2007 and 2017 were randomly divided into derivation (n = 383) and validation (n = 128) cohorts. To develop the risk score, clinical parameters were built by logistic regression to predict (1) ≥ 50% total bilirubin (TB) resolution within 2 weeks and (2) bilirubin normalization (TB level <1.2 mg/dL) within 6 weeks following stenting. The scoring scheme was applied to the validation cohort to test its performance.

A ≥ 50% TB resolution within 2 weeks was shown in 70.5% of cases. The risk scoring scheme had areas under the receiver operating characteristic curve (AUROC) of 0.70 (95% CI, 0.64–0.76) and 0.67 (95% CI, 0.57–0.77) in the derivation and validation cohorts, respectively. Thirty-one percent had TB normalization within 6 weeks after stenting. Significant predictors for TB normalization were extrahepatic biliary obstruction (odds ratio [OR] = 2.35), pre-endoscopic TB level (OR = 0.88), and stent type (OR = 0.42). The AUROC of a risk score for predicting TB normalization within 6 weeks was 0.78 (95% CI, 0.72–0.83) and 0.76 (95% CI, 0.67–0.86) in the derivation and validation cohorts, respectively. A score > 1.30 yielded a specificity of 98% and a positive predictive value of 84% for predicting TB normalization. A score of < -4.18 provided a sensitivity of 80%–90% and a negative predictive value of 90%–93% for predicting the absence of TB normalization.

The pre-endoscopic scoring system comprising biliary obstruction level, liver biochemistry, and type of stent provides prediction indices for TB normalization within 6 weeks after stenting. This scheme may help endoscopists identify patients with unresectable MBO suited for palliative stenting.

• Bilirubin
• Cholestasis/etiology
• Cholestasis/surgery
• Cholestasis, Extrahepatic
• Drainage
• Humans
• Neoplasms
• Risk Factors
• Stents

• Biliary obstruction
• Gall bladder carcinoma
• Obstructive jaundice
• PTBD

Radical surgical resection is regarded as the best treatment for hepatic hilar cholangiocarcinoma. However, 60%-70% of patients have lost the chance of surgery at the time of diagnosis. Simple biliary stent or drainage tube placement may fail in a short time due to tumor invasion or overgrowth, bile accumulation, or biofilm formation. Effective palliative treatments to extend the effective drainage time are of great significance for improving the quality of life of patients and changing the prognosis of patients.

To investigate the clinical efficacy of gemcitabine and cisplatin-based transcatheter arterial chemoembolization (TACE) combined with radiotherapy in hilar cholangiocarcinoma.

A retrospective analysis was conducted on patients clinically diagnosed with hilar cholangiocarcinoma from June 2014 to January 2017 at the Liaoning Provincial Cancer Hospital. Patients were evaluated by specialists, and those who were not suitable for surgery or unwilling to undergo surgery and met the inclusion criteria were included in the study. There were a total of 72 patients (34 males and 38 females) with an average age of 59.9 years (range, 40-72 years). According to percutaneous transhepatic biliary angiography and the patients’ wishes, stent implantation or biliary drainage tube implantation was used to relieve biliary obstruction. The patients were divided into either a control group or a combined treatment group according to their follow-up treatment. The control group consisted of a total of 35 patients who received simple biliary drainage tube placement and biliary stent implantation (7 patients with bilateral stents and 6 with a unilateral stent) and 22 patients receiving biliary drainage tube placement alone. The combined treatment group received TACE and extracorporeal radiotherapy after biliary drainage or biliary stent implantation and consisted of a total of 37 patients, including 21 patients receiving combined treatment after biliary stent placement (14 patients with bilateral stents and 7 with a unilateral stent) and 16 undergoing combined therapy after implanting the biliary drainage tube. In the combination treatment group, the TACE chemotherapy regimen employed gemcitabine and cisplatin, and the embolic agent was iodized oil. A particular dose was determined according to the patient's body surface area and the tumor staining indicated by DSA. In vitro radiotherapy was performed with intensity-modulated radiotherapy or three-dimensional conformal radiotherapy at an average dose of 48.3 Gy. Both groups were followed from stent implantation or drainage tube implantation until the patient quitted or died. The median length of follow-up observation was 13 mo. The differences in overall survival time and the effect of different jaundice reducing methods (single stent, double stent, or biliary drainage) on the patency time and survival time of biliary stents were compared between the two groups; the related factors affecting overall survival time were analyzed.

The median survival time of the control group was 10.5 mo; the median survival time of patients with biliary stent implantation and those with percutaneous biliary drainage was 9.6 mo and 11.4 mo, respectively, and there was no statistically significant difference between them. The median survival time of the combined treatment group was 20.0 mo, which was significantly higher than that of the control group (P < 0.05). Among patients in the combined treatment group, the median survival time of patients who underwent biliary stent implantation and those who accepted percutaneous biliary drainage before the combination therapy was 19.5 mo and 20.1 mo, respectively, and there was no significant difference between them. In the combination treatment group, the mean time of median stent patency was 15.6 mo, which was significantly higher than that of the control group (7.0 mo; P < 0.05). The independent factors affecting survival time included age, whether to receive combination therapy, percutaneous biliary drainage tube implantation, and Bismuth-Corlette classification as type IV.

Gemcitabine and cisplatin-based TACE combined with radiotherapy can prolong the survival of patients with hilar cholangiocarcinoma. Independent predictors of survival include selection of combination therapy, Bismuth-Corlette classification as type IV, selection of percutaneous biliary drainage tube implantation, and age.

• Hilar cholangiocarcinoma
• Biliary stent
• Percutaneous biliary drainage
• Gemcitabine
• Cisplatin
• Radiotherapy
• Transcatheter arterial chemoembolization