Photodynamic Therapy Combined with Biliary Drainage for Extrahepatic Cholangiocarcinoma: A propensity score–matched, single-center retrospective study.

Abstract

e16279 Background: Inoperable extrahepatic cholangiocarcinoma (eCCA) carries a poor prognosis. This study evaluates the efficacy and safety of photodynamic therapy (PDT) combined with biliary drainage (BD) versus BD alone. Methods: We retrospectively analyzed 86 eCCA patients from June 2021 to June 2025. Patients received PDT+BD (n = 39) or BD alone (n = 47). A 1:1 propensity score matching (PSM) was performed to balance baseline characteristics, including age, gender, tumor location, and TNM stage. Primary endpoint was overall survival (OS); secondary endpoints were complications and stent removal rate. Results: After PSM (n = 22/group), all baseline variables were well-balanced ( p > 0.05). The PDT+BD group showed significantly superior median OS compared to the BD group (17.8 vs. 6.4 months; p = 0.011). The 1-year OS rate was 60.5% (95% CI: 48.5–72.5) for PDT+BD versus 16.4% (95% CI: 8.1–24.7) for BD ( p < 0.001). 10.3% (4/39) in the PDT group achieved drainage independence due to lumen relief, versus 0% in the BD group ( p = 0.039). Subgroup analysis confirmed that the survival benefit remained significant even for patients receiving only a single PDT session (mOS 17.8 vs. 6.4 months; p = 0.022). The overall complication rate post-PSM was identical between the PDT+BD and BD groups (18.2% vs. 18.2%; p = 1.000). Conclusions: PDT combined BD significantly prolongs OS in eCCA patients without increasing procedural risks. The higher rate of drainage independence highlights PDT's efficacy in local tumor control. Characteristics and clinical outcomes of patients before and after propensity score matching. Variable Pre-PSM PDT (n=39) Pre-PSM BD (n=47) P -value¹ Post-PSM PDT (n=22) Post-PSM BD (n=22) P -value² Tumor Location, n (%) <0.001 0.750 - Hilar Cholangiocarcinoma 16 (41.0%) 36 (76.6%) 15 (68.2%) 14 (63.6%) - Distal Cholangiocarcinoma 23 (59.0%) 11 (23.4%) 7 (31.8%) 8 (36.4%) TNM Stage, n (%) 0.188 0.728 - Stage III 30 (76.9%) 30 (63.8%) 17 (77.3%) 16 (72.7%) - Stage IV 9 (23.1%) 17 (36.2%) 5 (22.7%) 6 (27.3%) Median Overall Survival 17.8 mo 5.7 mo <0.01 17.8 mo 6.4 mo 0.011 1-Year Survival Rate, % 59.5% 22.0% <0.001 60.5% 16.4% <0.001 Stent Removal Rate, % (n/N) 10.3% (4/39) 0% (0/47) 0.039 — — — 1 P -value for comparison between PDT and Stent groups before PSM. 2 P -value for comparison between PDT and Stent groups after PSM.