Cha Byung Hyo, Jang Myoung-Jin, Lee Sang Hyub
Division of Internal Medicine, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates.
Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Clin Endosc. 2021 Jan;54(1):100-106. doi: 10.5946/ce.2020.254. Epub 2021 Jan 15.
BACKGROUND/AIMS: Cholangiocarcinoma (CCA) is a rare but aggressive disease with a poor survival. Recent trials have shown improved survival with intraductal radiofrequency ablation (RFA) therapy. We performed a systematic review with meta-analysis to determine the survival benefit of endoscopic RFA for unresectable extrahepatic CCA with malignant biliary obstruction (MBO).
A systematic search from 1970 to 2020 was performed in MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials. gov. We selected eligible studies reporting relative risks, hazard ratios (HRs), or odds ratios, adjusted by controlling for confounding factors of survival rate and stent patency duration, among patients with extrahepatic CCA with MBO treated with RFA with stent insertion or stent insertion only.
A total of eight trials (three randomized and five nonrandomized) with a total of 420 patients were included in the metaanalysis. Pooled overall survival analysis favored RFA treatment with stent insertion (HR, 0.47; 95% confidence interval [CI], 0.34- 0.64; I2=47%; p=0.09); however, no significant difference was found in the duration of stent patency between the groups (HR, 0.79; 95% CI, 0.57-1.09; I2=7%; p=0.36).
RFA therapy with stent insertion may confer a survival benefit compared with stent insertion only in patients with CCA and MBO.
背景/目的：胆管癌（CCA）是一种罕见但侵袭性强、生存率低的疾病。近期试验表明，导管内射频消融（RFA）治疗可提高生存率。我们进行了一项系统评价和荟萃分析，以确定内镜下RFA治疗不可切除的肝外CCA合并恶性胆管梗阻（MBO）的生存获益。
在MEDLINE、EMBASE、Cochrane图书馆和ClinicalTrials.gov上对1970年至2020年进行了系统检索。我们选择了符合条件的研究，这些研究报告了接受RFA联合支架置入或仅支架置入治疗的肝外CCA合并MBO患者的相对风险、风险比（HR）或比值比，并通过控制生存率和支架通畅持续时间的混杂因素进行了调整。
荟萃分析共纳入8项试验（3项随机试验和5项非随机试验），共420例患者。汇总的总生存分析支持RFA联合支架置入治疗（HR，0.47；95%置信区间[CI]，0.34 - 0.64；I2 = 47%；p = 0.09）；然而，两组间支架通畅持续时间无显著差异（HR，0.79；95% CI，0.57 - 1.09；I2 = 7%；p = 0.36）。
对于CCA合并MBO患者，与单纯支架置入相比，RFA联合支架置入治疗可能带来生存获益。
