Safety evaluation of drug-eluting bead transarterial chemoembolization in combination with immune checkpoint inhibitors in the treatment of unresectable intrahepatic cholangiocarcinoma: risk factors for liver abscess.

PURPOSE This study compared the incidence of adverse events in patients with unresectable intrahepatic cholangiocarcinoma (ICC) receiving drug-eluting bead transarterial chemoembolization (DEB-TACE) either alone or in combination with immune checkpoint inhibitors (ICIs).

METHODS A retrospective analysis was conducted on patients with unresectable ICC who received either DEB-TACE alone or in combination with ICIs treatment from February 2019 to April 2024. Of the enrolled 247 ICC patients, 178 received DEB-TACE combined with ICIs treatment, while 69 patients received DEB-TACE alone. Adverse events were recorded and compared between the two groups. Binary logistic regression analysis was used to determine the significant risk factors of adverse events.

RESULTS The overall incidence of adverse events was 19.1% (34/178) in the DEB-TACE+ICIs group and 13.0% (9/69) in the DEB-TACE group. The DEB-TACE+ICIs group exhibited a statistically significantly higher incidence of liver abscesses than the DEB-TACE group (13.5% vs. 2.9%, P = 0.015). Binary logistic regression analysis showed that combined ICIs treatment (P = 0.027, odds ratio = 5.583, 95% confidence interval: 1.212-25.725) and grade 1 artery occlusion (P = 0.001, odds ratio = 31.380, 95% confidence interval: 4.098-240.263) were independently associated with an increased risk of developing liver abscess.

CONCLUSION Combined ICIs treatment and grade 1 arterial occlusion were independently associated with an increased risk of liver abscesses. Clinicians should closely monitor for liver abscess formation when administering DEB-TACE in combination with ICIs, particularly in patients with grade 1 arterial occlusions.