P0005 (S0011). - Palliative Endoscopic and Percutaneous Biliary Radiofrequency Ablation With Stenting Compared to Biliary Stenting Alone in the Treatment of Unresectable Cholangiocarcinoma: A Meta-Analysis on Survival Outcomes
Jeffrey Rebhun, MD, Edward C. Villa, MD; University of Illinois at Chicago, Chicago, IL
Introduction: Cholangiocarcinoma (CCA) is a rare gastrointestinal tumor that carries a significant morbidity and mortally rate. Endoscopic (ERFA) and percutaneous biliary radiofrequency ablation (PRFA) are novel technologies with good safety profiles for patients with previously untreated, unresectable cholangiocarinoma. This study aims to compare pooled survival outcomes in patients undergoing ERFA and PRFA with biliary stenting compared with stenting alone. Methods: A comprehensive literature review was conducted querying the PubMed database for published manuscripts and abstracts comparing survival outcomes of patients undergoing either PRFA or ERFA and stenting with stenting alone. Only studies that included CCA-specific survival data for untreated, unresectable disease were analyzed. Pooled data was used to generate a Kaplan Meier survival curve with log-rank test performed to compare differences in survival. Results: There were 4 studies comparing patients undergoing ERFA and stenting (106 patients) with stenting alone (101 patients); and 2 studies comparing patients undergoing PRFA and stenting (60 patients) with stenting alone (50 patients). One study compared patients undergoing either PRFA or ERFA (30 patients) with stenting alone (35 patients). The mean survival of the ERFA with stenting group (11.7 + 1.0 months) was significantly longer than mean survival of the biliary stent control group (7.5 + 1.8 months, p< .0001). There was no significant difference when comparing mean survival of the PRFA with stenting group (7.7 + 3.6 months) and the biliary stent control group (7.5 + 1.8 months, p=.7). Cumulative mean survival of all patients undergoing biliary RFA (10.6 + 6.2 months) was significantly longer than that of the biliary stent control group (7.5 + 1.8 months, p < 0.0001). Similarly, median survival of the ERFA with stent group (13 months, log-rank test z = 5.7, p < 0.001) and the median survival of all patients undergoing biliary RFA (10.1 months, log rank test z = 4.0, p < 0.001) were statistically superior to the median cumulative survival of biliary stent control patients (8.1 months). However, the median survival of patients in the PRFA with stent group (5.2 months, log-rank test z = 1.3, p =0.2) was not significantly different from the cumulative biliary stent group. Discussion: Biliary RFA with concomitant biliary stenting, overall, seems a promising palliative option for those with previously untreated unresectable cholangiocarcinoma with evidence of increased mean survival.
Figure 1: Forest Plot of mean survival in patients with untreated, unresectable cholangiocarcinoma treated with ERFA and biliary stenting, PRFA and biliary stenting, or biliary stenting alone
Figure 2: Kaplan-Meier survival curve of patients with untreated, unresectable cholangiocarcinoma treated with ERFA and biliary stenting, PRFA and biliary stenting, or biliary stenting alone
Disclosures: Jeffrey Rebhun indicated no relevant financial relationships. Edward Villa: Olympus Corporation – Consultant.