[Efficacy of photodynamic therapy in extrahepatic cholangiocarcinoma]

Objective: To investigate the safety and efficacy of photodynamic therapy(PDT) combined with biliary stent implantation in the treatment of extrahepatic cholangiocarcinoma. Methods: A retrospective cohort analysis was conducted based on the clinical and imaging data of patients with extrahepatic cholangiocarcinoma admitted to the First Affiliated Hospital of Xi'an Jiaotong University from June 2021 to June 2025. Eighty-six patients were enrolled in this study, there were 59 males and 27 females, with an age of (70.2±9.0) years (range: 37 to 91 years). Patients were divided into two groups according to the treatment regimen: the PDT combined with biliary stent implantation group (39 cases) and the biliary stent implantation group (47 cases). A 1∶1 nearest-neighbor propensity score matching (PSM) was performed with a caliper width of 0.1. Furthermore, patients in the PDT group were subclassified into the percutaneous transhepatic cholangiography (PTC) subgroup and the endoscopic retrograde cholangiopancreatography (ERCP) subgroup based on the intervention approach. The postoperative complication rate and postoperative overall survival time were compared by independent samples t-test, Mann-Whitney U test, χ² test or Fisher's exact test between the two groups. Survival analysis was conducted using the Kaplan-Meier method, and the Log-rank test was applied for intergroup comparisons. Results: After PSM matching,the overall incidence of postoperative complications was 18.2% (4/22) in both the PDT group and the stenting group, with no statistically significant difference (P>0.05). No significant differences were observed in the incidence of each specific complications between the two groups (all P>0.05). Survival analysis showed that the median overall survival (mOS) time of the PDT combined with stent group and the stent group were 17.8 months and 6.4 months,respectively,with a statistically significant difference (P=0.011). For PDT patients undergoing the PTC versus ERCP approach, the incidence of postoperative complications was 18.5% (5/27) and 2/12, respectively; the mOS time was 17.8 months versus not reached, with no statistically significant difference (all P>0.05). Conclusions: PDT combined with biliary stent implantation can effectively prolong the overall survival time of patients with extrahepatic cholangiocarcinoma without increasing the risk of postoperative complications. Additionally,the administration of PDT via the PTC and ERCP approaches has no significant impact on the therapeutic efficacy and safety.