Efficacy and safety of hepatic arterial infusion chemotherapy plus lenvatinib and PD-1/PD-L1 inhibitors versus systemic chemotherapy plus lenvatinib and PD-1/PD-L1 inhibitors in advanced unresectable cholangiocarcinoma: a retrospective cohort study.

Regarding distant control, while the HAIC cohort (90.3%) showed a trend toward better control compared to the systemic therapy cohort (72.7%), the difference was not statistically significant ( P = 0.071).At the first reassessment (C2, Supplementary Table 2 ), most patients remained at stage IV with multiple metastases, and intergroup differences in tumor burden or hematologic indices were not significant.

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Logistic regression (Supplementary Table 6 ) analyses confirmed second-line treatment (OR = 9.745, P = 0.003) and impaired baseline ALBI (OR = 3.750, P = 0.048) as independent adverse prognostic factors, with ECOG-PS showing a near-significant trend ( P = 0.075).

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The median OS was 24.1 months in the HAIC group versus 15.5 months in the systemic therapy group, although this difference did not reach statistical significance in the unadjusted analysis ( P = 0.130).

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