Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2021; 9(35): 10979-10993
Published online Dec 16, 2021. doi: 10.12998/wjcc.v9.i35.10979
Percutaneous biliary stent combined with brachytherapy using 125I seeds for treatment of unresectable malignant obstructive jaundice: A meta-analysis
Wei-Yue Chen, Chun-Li Kong, Miao-Miao Meng, Wei-Qian Chen, Li-Yun Zheng, Jian-Ting Mao, Shi-Ji Fang, Li Chen, Gao-Feng Shu, Yang Yang, Qiao-You Weng, Min-Jiang Chen, Min Xu, Jian-Song Ji
Wei-Yue Chen, Chun-Li Kong, Miao-Miao Meng, Wei-Qian Chen, Li-Yun Zheng, Jian-Ting Mao, Shi-Ji Fang, Li Chen, Gao-Feng Shu, Yang Yang, Qiao-You Weng, Min-Jiang Chen, Min Xu, Jian-Song Ji, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
Author contributions: Chen WY, Kong CL, and Meng MM acquired, analyzed, and interpreted the data, and drafted the manuscript; Chen WQ, Zheng LY, Mao JT, and Fang SJ analyzed the data and drafted the manuscript; Chen L, Shu GF, and Yang Y interpreted the data and revised the manuscript; Ji JS, Xu M, Chen MJ, and Weng QY conceptualized and designed the study, and critically revised the manuscript; all authors approved the final manuscript.
Supported by the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission, No. 2020KY1086 and No. 2020KY1087.
Conflict-of-interest statement: The authors deny any conflict of interest related to this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Song Ji, MD, PhD, Chief Doctor, Surgical Oncologist, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, No. 289 Kuocang Road, Liandu District, Lishui 323000, Zhejiang Province, China. jijiansong@zju.edu.cn
Received: June 24, 2021
Peer-review started: June 24, 2021
First decision: July 27, 2021
Revised: August 3, 2021
Accepted: November 2, 2021
Article in press: November 2, 2021
Published online: December 16, 2021
Processing time: 168 Days and 15.4 Hours
Abstract
BACKGROUND

Malignant obstructive jaundice (MOJ) is a common pathologic manifestation of malignant biliary obstruction. Recently, several clinical trials have explored the clinical effectiveness of intraluminal 125I seed-based brachytherapy for MOJ patients, and various outcomes have been reported.

AIM

To assess the efficacy and safety of percutaneous biliary stents with 125I seeds compared to conventional metal stents in patients with unresectable MOJ.

METHODS

A systematic search of English-language databases (PubMed, Embase, Cochrane Library, and Web of Science) was performed to identify studies published prior to June 2020 that compared stents with or without 125I seeds in the treatment of unresectable MOJ. The outcomes analyzed included primary outcomes (stent patency and overall survival) and secondary outcomes (complications and liver function parameters).

RESULTS

Six randomized controlled trials and four retrospective studies involving 875 patients were eligible for the analysis. Of the 875 included patients, 404 were treated with 125I seed stents, while 471 were treated with conventional stents. Unadjusted pooled analysis demonstrated that compared to conventional stents, 125I seed stents extended the stent patency time [hazard ratio (HR) = 0.36, 95% confidence interval (CI) = 0.28-0.45, P < 0.0001] and overall survival period (HR = 0.52, 95%CI = 0.42–0.64, P < 0.00001). Subgroup analyses based on the type of 125I seed stent and type of study design showed consistent results. However, there were no significant differences in the occurrence of total complications [odds ratio (OR) = 1.12, 95%CI = 0.75-1.67, P = 0.57], hemobilia (OR = 1.02, 95%CI = 0.45-2.3, P = 0.96), pancreatitis (OR = 1.79, 95%CI = 0.42-7.53, P = 0.43), cholangitis (OR = 1.13, 95%CI = 0.60-2.13, P = 0.71), or pain (OR = 0.67, 95%CI = 0.22-2, P = 0.47). In addition, there were no reductions in the levels of serum indices, including total bilirubin [mean difference (MD) = 10.96, 95%CI = -3.56-25.49, P = 0.14], direct bilirubin (MD = 7.37, 95%CI = -9.76-24.5, P = 0.4), alanine aminotransferase (MD = 7.52, 95%CI = -0.71-15.74, P = 0.07), and aspartate aminotransferase (MD = -4.77, 95%CI = -19.98-10.44, P = 0.54), after treatment. Publication bias was detected regarding the outcome overall survival; however, the conclusions were not changed after the adjustment.

CONCLUSION

Placement of stents combined with brachytherapy using 125I seeds contributes to a longer stent patency and higher overall survival than placement of conventional stents without extra complications or severe liver damage. Thus, it can be considered an effective and safe treatment for unresectable MOJ.

Keywords: Malignant obstructive jaundice; Brachytherapy; 125I seed; Patency; Survival; Meta-analysis

Core Tip: In recent years, the incidence of malignant obstructive jaundice (MOJ) in Asia has been 40 times higher than that in the Western world, which is a vital issue that requires significant attention. Irradiation stents using 125I seeds have been widely applied in the treatment of unresectable MOJ. However, more convincing evidence-based reviews of the efficacy and safety of 125I seed stents are needed. We used the latest data to further validate the superiority of 125I seed stents, providing strong evidence for clinicians to make correct decisions in clinical practice. Furthermore, we found that 125I seed stents resulted in equivalent complication and serum index outcomes as conventional stents, indicating that 125I seed stents are safe and well tolerated.