肿瘤相关性肝衰竭（TRLF）是肝内胆管癌（ICC）患者最常见的死因。虽然我们之前显示，对于局部晚期ICC患者，肝放射治疗（L-RT）与TRLF发生较少和总生存期（OS）较长有关，但L-RT在伴有肝外转移病变（M1）的患者中的作用尚未确定。我们旨在比较接受L-RT和未接受L-RT治疗的M1类ICC患者的疗效。我们回顾了2010年至2021年期间在单一机构发现初诊M1疾病的ICC患者，对照机构队列进行倾向性评分匹配，并使用国家癌症数据库（NCDB）队列进行频率技术匹配。L-RT的中位生物效应剂量为97.5 Gy（四分位距80.5-97.9 Gy）。我们排除了接受其他局部治疗或单纯支持性治疗的患者。我们通过Cox比例风险建模分析了生存率。我们确定了61名接受L-RT和220名接受化疗单一治疗的患者。在诊断后中位随访11个月后，单独接受化疗和接受L-RT治疗的患者的中位OS分别为9个月（95％置信区间[CI]为8-11）和21个月（CI为17-26）。单独接受化疗的患者因TRLF导致的死亡率明显高于接受L-RT的患者（82％对47％；p = 0.001）。在多变量倾向性评分匹配分析中，与较低死亡风险相关的因素包括初始化疗的持续时间（风险比[HR] 0.82；p = 0.005）和接受L-RT治疗（HR：0.40；p = 0.002）。NCDB化疗单组的诊断至死亡的中位OS短于机构L-RT组（9个月对22个月；p < 0.001）。对于M1类ICC，与接受单独化疗治疗的患者相比，L-RT与TRLF导致的死亡率较低，OS较长。有必要进行该情况下的前瞻性研究。© 2023 The Author(s). Published by S. Karger AG, Basel.

Tumor-related liver failure (TRLF) is the most common cause of death in patients with intrahepatic cholangiocarcinoma (ICC). Though we previously showed that liver radiotherapy (L-RT) for locally advanced ICC is associated with less frequent TRLF and longer overall survival (OS), the role of L-RT for patients with extrahepatic metastatic disease (M1) remains undefined. We sought to compare outcomes for M1 ICC patients treated with and without L-RT.We reviewed ICC patients that found to have M1 disease at initial diagnosis at a single institution between 2010 and 2021 who received L-RT, matching them with an institutional cohort by propensity score and a National Cancer Database (NCDB) cohort by frequency technique. The median biologically effective dose was 97.5 Gy (interquartile range 80.5-97.9 Gy) for L-RT. Patients treated with other local therapies or supportive care alone were excluded. We analyzed survival with Cox proportional hazard modeling.We identified 61 patients who received L-RT and 220 who received chemotherapy alone. At median follow-up of 11 months after diagnosis, median OS was 9 months (95% confidence interval [CI] 8-11) and 21 months (CI: 17-26) for patients receiving chemotherapy alone and L-RT, respectively. TRLF was the cause of death more often in the patients who received chemotherapy alone compared to those who received L-RT (82% vs. 47%; p = 0.001). On multivariable propensity score-matched analysis, associations with lower risk of death included duration of upfront chemotherapy (hazard ratio [HR] 0.82; p = 0.005) and receipt of L-RT (HR: 0.40; p = 0.002). The median OS from diagnosis for NCDB chemotherapy alone cohort was shorter than that of the institutional L-RT cohort (9 vs. 22 months; p < 0.001).For M1 ICC, L-RT associated with a lower rate of death due to TRLF and longer OS versus those treated with chemotherapy alone. Prospective studies of L-RT in this setting are warranted.© 2023 The Author(s). Published by S. Karger AG, Basel.