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.