The Impact of Radiofrequency Ablation on Survival Outcomes and Stent Patency in Patients with Unresectable Cholangiocarcinoma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
by
, , , , , , ,
Daniele Balducci
1
,
Michele Montori
1,
Francesco Martini
1,
Marco Valvano
2,3,
Federico De Blasio
1,
Maria Eva Argenziano
1
,
Giuseppe Tarantino
1,
Antonio Benedetti
1,
Emanuele Bendia
4,
Marco Marzioni
1 and
Luca Maroni
1,* 1
Clinic of Gastroenterology, Hepatology, and Emergency Digestive Endoscopy, Università Politecnica delle Marche, 60126 Ancona, Italy
2
Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
3
Division of Gastroenterology, Galliera Hospital, 16128 Genoa, Italy
4
Division of Digestive Diseases, Digestive Endoscopy and Inflammatory Bowel Diseases, A.O.U. “Ospedali Riuniti”, 60126 Ancona, Italy
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(7), 1372; https://doi.org/10.3390/cancers16071372
Submission received: 1 March 2024
/
Revised: 25 March 2024
/
Accepted: 29 March 2024
/
Published: 30 March 2024
(This article belongs to the Collection Treatment of Hepatocellular Carcinoma and Cholangiocarcinoma)
Simple Summary
This study investigated the efficacy of combining radiofrequency ablation (RFA) with stenting versus stenting alone in treating inoperable cholangiocarcinoma. Through a systematic review and meta-analysis of randomized controlled trials, it assessed the impact of the treatment on overall survival and stent patency. Although the results show no significant difference in overall survival between the groups, there was a trend toward improved survival in the subgroup treated with RFA plus plastic stents. Stent patency was significantly better in the RFA group. Adverse events were not different between the groups. These findings suggest that RFA may offer benefits in palliative care for these patients, warranting further research to explore the potential cumulative effects of RFA.
Abstract
Endoluminal biliary radiofrequency ablation (RFA) has been proposed as a palliative treatment for patients with malignant biliary obstruction (MBO) in order to improve stent patency and survival. However, the existing data on patients with inoperable extrahepatic cholangiocarcinoma (eCCA) are conflicting. We performed a meta-analysis of randomized trials comparing RFA plus stenting versus stenting alone in patients with inoperable eCCA. We searched for trials published in the PubMed/MEDLINE, Scopus, and Cochrane databases up to November 2023. Data extraction was conducted from published studies, and a quality assessment was carried out in accordance with the guidelines recommended by the Cochrane Collaboration. Hazard ratios (HRs) with 95% CI were estimated from the trials. The primary endpoints of interest were overall survival and stent patency. Out of 275 results, 5 randomized trials and 370 patients were included. While overall survival was not different between the groups (HR 0.62; 95% CI 0.36–1.07; p = 0.09; I2 = 80%;), the subgroup analysis of studies employing plastic stents showed a trend toward better survival in the RFA-treated group (HR 0.42; 95% CI 0.22–0.80; p = 0.009; I2 = 72%). Stent patency was improved in patients receiving RFA (HR 0.64; 95% CI 0.45–0.90; p = 0.01; I2 = 23%). Adverse events were not different between the groups (OR 1.21; 95% CI 0.69–2.12; p = 0.50; I2 = 0%). Despite the promising results, high heterogeneity and potential biases in the included studies suggest the need for further high-quality randomized trials to explore the potential cumulative effects of RFA on CCA treatment outcomes.
Keywords:
radiofrequency ablation; cholangiocarcinoma; stenting; survival; meta-analysis
