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Review
. 2024 Mar 30;16(7):1372.
doi: 10.3390/cancers16071372.

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

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 , Luca Maroni  1
Affiliations
Review

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

Daniele Balducci et al. Cancers (Basel). .

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: cholangiocarcinoma; meta-analysis; radiofrequency ablation; stenting; survival.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of study screening and selection.
Figure 2
Figure 2
Pooled hazard ratios (HRs) for overall survival [16,17,18,19,20].
Figure 3
Figure 3
Pooled hazard ratios (HRs) for stent patency [16,17,19,20].
Figure 4
Figure 4
Pooled analysis of adverse events [16,17,18,19].
Figure 5
Figure 5
Risk-of-bias summary for randomized studies (RoB 2) [16,17,18,19,20].
Figure 6
Figure 6
Post hoc analysis without Yang et al. [16,18,19,20].
See this image and copyright information in PMC

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