Impact of Multimodal Oncological Therapy on Survival and Local Control in Unresectable Perihilar Cholangiocarcinoma

This study aimed to evaluate the safety and effectiveness of targeted multimodal oncological therapy in patients with unresectable hilar cholangiocarcinoma (HCCA) presenting with obstructive jaundice, particularly those with the nodular-infiltrating morphological type.

A total of 104 patients with Bismuth type III, nodular-infiltrating HCCA were analyzed. Fifty-two patients received percutaneous transhepatic biliary stenting (PTBS) combined with intraluminal ¹²⁵I seed strand placement, percutaneous ¹²⁵I seed implantation, and regional chemotherapy, whereas the remaining 52 patients received percutaneous transcatheter biliary drainage tube placement plus systemic chemotherapy. Overall survival (OS), progression-free survival (PFS), and biliary patency duration were compared between groups. Univariate and multivariate Cox regression analyses were performed to identify liver function biomarkers associated with prognosis.

Intraluminal brachytherapy and percutaneous ¹²⁵I seed implantation were successfully completed in all 52 patients in the multimodal treatment group. Compared with the drainage plus systemic chemotherapy group, patients receiving multimodal therapy had significantly longer median OS (22.0 vs. 10.0 months, p < 0.001), median PFS (14.1 vs. 5.9 months), and biliary patency duration (21.0 vs. 9.0 months, p < 0.001). Multivariate analysis showed that total bilirubin and albumin were independent prognostic factors for OS in patients treated with brachytherapy and regional chemotherapy. In the drainage plus systemic chemotherapy group, total bilirubin, albumin, and alkaline phosphatase were independently associated with OS. No serious complications, such as massive hemorrhage or bile leakage, were observed.

Targeted multimodal oncological therapy may achieve durable local disease control, prolong biliary patency, and improve survival in patients with unresectable nodular-infiltrating HCCA accompanied by obstructive jaundice. Future studies should further consider tumor morphological characteristics and liver function biomarkers when refining treatment strategies and prognostic assessment.