Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China.
Department of Gastroenterology, Third Affiliated Hospital, Second Military Medical University, Shanghai, China.
J Hepatobiliary Pancreat Sci. 2022 Jun;29(6):693-702. doi: 10.1002/jhbp.960. Epub 2021 Apr 24.
Endoscopic radiofrequency ablation (RFA) is an emerging technique for the palliation of inoperable malignant biliary strictures (MBSs). We aimed to systemically investigate the long-term outcome of RFA in a large cohort of patients.
We recruited 883 patients with various MBSs who underwent endoscopic interventions at two large-volume centers; 124 patients underwent RFA and stenting, whereas 759 underwent stenting alone. To overcome selection bias, we performed 1:4 propensity score matching (PSM). The main outcome was overall survival (OS).
Following PSM, patients in the RFA group showed significantly longer OS (9.5 months; 95% CI: 7.7-11.3 months) than those in the stenting alone group (6.1 months; 95% CI: 5.6-6.6 months; P < .001). In stratified analyses, the improved OS was only demonstrated in the subgroup of extrahepatic cholangiocarcinoma (11.3 months 95% CI: 10.2-12.4 vs 6.9 months 95% CI: 6.0-7.8; P < .001), but not in the subgroups of gallbladder cancer, hepatocellular carcinoma, intrahepatic cholangiocarcinoma, pancreatic cancer, and other metastatic cancers (all P > .05). The survival benefits were noted only in the patients with non-metastatic cholangiocarcinoma (11.5 vs 7.4 months, P < .001).
The survival benefits of endoscopic RFA appear to be limited to patients with extrahepatic cholangiocarcinoma without distant metastasis.
内镜下射频消融(RFA)是一种治疗不可切除的恶性胆道狭窄(MBS)的新兴技术。我们旨在通过一项大样本患者队列的研究,系统性地评估 RFA 的长期疗效。
我们招募了在两个大容量中心接受内镜干预的 883 例各种 MBS 患者;其中 124 例患者接受了 RFA 和支架置入,759 例患者仅接受了支架置入。为了克服选择偏倚,我们进行了 1:4 的倾向评分匹配(PSM)。主要结局是总生存期(OS)。
在 PSM 后,RFA 组患者的 OS 明显长于单独支架置入组(9.5 个月;95%CI:7.7-11.3 个月)(6.1 个月;95%CI:5.6-6.6 个月;P<0.001)。分层分析显示,OS 的改善仅在肝外胆管癌亚组中得到证实(11.3 个月,95%CI:10.2-12.4 个月比 6.9 个月,95%CI:6.0-7.8 个月;P<0.001),而在胆囊癌、肝细胞癌、肝内胆管癌、胰腺癌和其他转移性癌症亚组中均未见(均 P>0.05)。生存获益仅见于无远处转移的非转移性胆管癌患者(11.5 个月比 7.4 个月,P<0.001)。
内镜下 RFA 的生存获益似乎仅限于无远处转移的肝外胆管癌患者。