Jeffrey Rebhun, MD, Edward C. Villa, MD; University of Illinois at Chicago, Chicago, IL
Introduction: Unresectable cholangiocarcinoma (CCA) carries an extremely poor prognosis with median patient survival between 3-6 months. A mainstay of palliative treatment is endoscopic or percutaneous biliary stenting which offers little survival improvement. Endoscopic radiofrequency ablation (ERFA) and percutaneous radiofrequency ablation (PRFA) are newer therapies and in conjunction to stent placement, may offer improved survival. This meta-analysis aims to compare survival data of patients undergoing ERFA and stent with those undergoing PRFA and stent for palliation of unresectable CCA. Methods: Using the PubMed database, a comprehensive literature review was conducted for manuscripts and abstracts comparing survival outcomes in patients undergoing ERFA with stenting and PRFA with stenting. Studies included provided a contingency of data allowing for extrapolation of survival outcomes related to CCA. Results: 4 studies of ERFA with stenting and 2 studies of PRFA with were included in our meta-analysis. The ERFA group had a longer mean survival time (11.7 + 1.0 months) when compared to pooled stent control groups (6.5 + 1.7, p < 0.0001). Similarly, the mean survival of the PRFA with stenting group (7.7 + 3.6 months) compared to the mean survival of the biliary stent control groups also differed significantly (p = 0.004, respectively). Of note, the mean survival difference between the cumulative ERFA with stent cohort compared to the PRFA with stent cohort differed significantly, favoring ERFA with stenting (difference = 4.0 + 0.4 months, 95% CI 3.3 to 4.7, p < 0.0001). Median survival of the ERFA with stenting group (13.0 months) was also statistically superior to the biliary stenting control group (7.0 months, log-rank test z = 5.7, p < 0.0001), while the median survival of the PRFA with stenting group (5.2 months) did not demonstrate superiority (log-rank test z = 1.3, p = 0.2). ERFA demonstrated statistical superiority when comparing median survival with that of PRFA (log-rank test z = 5.3, p < 0.0001). Discussion: While there is no published literature directly comparing outcomes of ERFA with biliary stenting and PRFA with biliary stenting, our meta-analysis of published studies analyzing each modality demonstrated superiority of ERFA as compared to PRFA in both mean and median survival and as compared to biliary stenting alone. Comparative studies are needed to derive meaningful differences in survival outcomes.
Figure 1: Forest Plot of mean survival of patients undergoing ERFA with stenting compared to PRFA with stenting in patients with untreated, unresectable cholangiocarcinoma.
Figure 2: Kaplan-Meier survival curve of patients undergoing ERFA with stenting compared to PRFA with stenting in patients with untreated, unresectable cholangiocarcinoma.
Disclosures: Jeffrey Rebhun indicated no relevant financial relationships. Edward Villa: Olympus Corporation – Consultant.