P0003 (S0009). - Palliative Endoscopic 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 malignancy associated with significant morbidity and mortality. Patients with unresectable disease have an associated 5-year survival between 2-25% and a median survival of 3-6 months according to published literature. The mainstay of non-systemic palliative therapy includes intraductal stenting (plastic or metal) via percutaneous or endoscopic approaches. However, these measures have had marginal life-prolonging effects. Endobiliary radiofrequency ablation (ERFA) is a novel technique that, when used in conjunction with stenting, has demonstrated significant survival benefit. This meta-analysis aims to evaluate pooled survival data of the current published literature comparing ERFA and stenting with the conventional stent-only approach. Methods: A comprehensive literature search was conducted querying the PubMed database for published manuscripts and abstracts that analyzed survival data in patients undergoing ERFA with stenting and biliary stenting alone. Studies assessing post-surgical patients, treatment on recurrent lesions, or non-CCA related malignancies without contingency data to extrapolate CCA-specific data were excluded from the study. Pooled data was compiled to generate a Kaplan Meier curve with log-rank test performed to compare survival outcomes among the two groups. Results: A total of four studies met inclusion criteria and were analyzed for quantitative outcomes. A total of 106 patients underwent ERFA with stenting compared to 101 patients that had biliary stenting alone. The mean survival of the ERFA with stenting group (11.7 + 0.7 months) and the biliary stent control group (6.8 +/- 0.3 months) differed significantly (mean difference of 4.9 +/- 0.1 months, 95% CI 4.8-5.0, p < 0.0001). Likewise, median survival differed significantly between the patients undergoing ERFA with stenting (13 months) as compared to those undergoing biliary stenting alone (8 months; log-rank test z = 4.8, p < 0.0001). Discussion: ERFA with biliary stenting may be a reasonable palliative therapy for those with previously untreated unresectable cholangiocarcinoma with evidence of increased mean and median survivals relative to biliary stenting alone. However, given the lack of available studies on this patient population, more longitudinal data is needed to draw conclusions of survival benefit.
Figure 1: Forest Plot of median survival of patients with untreated, unresectable cholangiocarcinoma treated with ERFA and stenting versus those treated with biliary stenting alone.
Figure 2: Kaplan-Meier survival curve of patients with untreated, unresectable cholangiocarcinoma treated with ERFA and stenting versus those treated with biliary stenting alone.
Disclosures: Jeffrey Rebhun indicated no relevant financial relationships. Edward Villa: Olympus Corporation – Consultant.