title: Biliary stenting for unresectable cholangiocarcinoma: A population-based study of long-term outcomes and hospital costs in Taiwan.
abstract: Few studies have compared percutaneous biliary stenting (PBS) and endoscopic biliary stenting (EBS) in terms of long-term effects on cholangiocarcinoma (CC), and few have systematically evaluated outcome associations in Taiwan. This study aimed to compare long-term outcomes between two treatments for unresectable CC: PBS and EBS. After propensity score matching (PSM) to reduce the effect of selection bias, 1002 CC patients were included in this analysis: 501 in the PBS group and 501 in the EBS group. The Kaplan-Meier method was used to construct the survival curve for all CC patients, and the Cox proportional hazards model was used for multivariate assessment of outcome predictors. After PSM, group comparisons revealed a significantly longer length of stay in the PBS group compared to the EBS group (25 days vs. 19 days, respectively; p < 0.001). Hospital costs were also significantly higher in the PBS group than in the EBS group (US$126,575 vs. US$89,326, respectively; p < 0.001). The median survival time was 3.7 months in all CC patients, 3.5 months in the PBS group, and 4.0 months in the EBS group. The 1-year, 3-year, and 5-year survival rates were 17.6%, 6.1%, and 3.2% in all CC patients; 16.6%, 4.8%, and 3.2% in the PBS group; and 18.6%, 7.27%, and 3% in the EBS group, respectively. The most important predictor of survival is extrahepatic CC. Medical professionals and healthcare providers should carefully consider the use of EBS for initial treatment of obstructive jaundice in patients with unresectable CC.
authors.affiliation: Department of Nursing, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
authors.forename: Ling-Chun
authors.initials: LC
authors.lastname: Yang
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Shi
authors.affiliation: Division of Hepatobiliary Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Huang
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Hepatobiliary Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Electronic address: ktlee@kmu.edu.tw.
authors.forename: King-Teh
authors.initials: KT
authors.lastname: Lee
mesh_terms: D000368:Aged; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000191:economics* / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D015607:Stents / Q000191:economics*; D016019:Survival Analysis; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
keywords: Biliary tract stenting treatment; Cholangiocarcinoma; Hospital costs; Length of stay; Survival rate