Outcomes of Patients With Unresectable Cholangiocarcinoma After Portal Vein Embolization: A Propensity Score-Matched Analysis.

Abstract

Background: This study aimed to evaluate the outcomes of patients with unresectable cholangiocarcinoma (CCA) who underwent portal vein embolization (PVE) with a focus on overall survival (OS) and the frequency of biliary drainage (BD).

Methods: In this retrospective analysis, we evaluated 255 patients with unresectable CCA; 56 patients underwent PVE but ultimately remained unresectable. Propensity score matching (PSM) was used to minimize the potential confounding factors. The primary outcome was the OS, while the secondary outcome was BD frequency.

Results: The PVE-unresectable group showed lower OS than that in the non-PVE-unresectable group both before and after PSM (median OS: 238.5 vs. 371.0 days, p = 0.006; 238.5 vs. 483.5 days, p = 0.002, respectively). Unresectable PVE status was a predictor of worse survival both before and after PSM (hazard ratio [HR] = 2.06, p < 0.001 and HR = 2.46, p < 0.001, respectively). Chemotherapy improved survival before and after PSM (HR = 0.45, p < 0.001 and HR = 0.41, p = 0.003, respectively). The BD frequency was higher in the PVE-unresectable group than in the non-PVE-unresectable group before and after PSM (0.693 vs. 0.470 procedures per month, p = 0.010).

Conclusions: Patients with unresectable CCA who underwent PVE had worse survival outcomes and required BD. Optimizing systemic therapy and BD strategies may improve the outcomes.