Department of General Surgery, Wuxi Medical Center, Nanjing Medical University, Wuxi, China.
Liver Int. 2024 Sep;44(9):2208-2219. doi: 10.1111/liv.15984. Epub 2024 Jun 3.
Over recent years, there has been a notable rise in the incidence of intrahepatic cholangiocarcinoma (iCCA), which presents a significant challenge in treatment due to its complex disease characteristics and prognosis. Notably, the identification of fibroblast growth factor receptor 2 (FGFR2) fusion/rearrangement, a potential oncogenic driver primarily observed in iCCA, raises questions about its impact on the prognostic outcomes of patients undergoing surgical intervention or other therapeutic approaches.
A comprehensive search from inception to July 2023 was conducted across PubMed, Embase, Web of Science, and the Cochrane Library databases. The objective was to identify relevant publications comparing the prognosis of FGFR2 alterations and no FGFR2 alterations groups among patients with iCCA undergoing surgical resection or other systemic therapies. The primary outcome indicators, specifically Overall Survival (OS) and Disease-Free Survival (DFS), were estimated using Hazard Ratios (HRs) with 95% confidence intervals (CIs), and statistical significance was defined as p < .05. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Statistical analyses were performed using Review Manager 5.4 software and Stata, version 12.0.
Six studies, involving 1314 patients (FGFR2 alterations group n = 173 and no FGFR2 alterations group n = 1141), were included in the meta-analysis. The analysis revealed that the FGFR2 alterations group exhibited a significantly better OS prognosis compared to the no FGFR2 alterations group, with a fixed-effects combined effect size HR = 1.31, 95%CI = 1.001-1.715, p = .049. Furthermore, meta-regression and subgroup analysis showed that the length of the follow-up period did not introduce heterogeneity into the results. This finding indicates the stability and reliability of the study outcomes.
The current study provides compelling evidence that FGFR2 alterations are frequently associated with improved survival outcomes for patients with iCCA undergoing surgical resection or other systemic treatments. Additionally, the study suggests that FGFR2 holds promise as a safe and dependable therapeutic target for managing metastatic, locally advanced or unresectable iCCA. This study offers a novel perspective in the realm of targeted therapy for iCCA, presenting a new and innovative approach to its treatment.
近年来，肝内胆管癌（iCCA）的发病率显著上升，由于其复杂的疾病特征和预后，治疗极具挑战性。值得注意的是，纤维母细胞生长因子受体 2（FGFR2）融合/重排的鉴定，主要在 iCCA 中观察到的潜在致癌驱动因素，引发了对其对接受手术干预或其他治疗方法的患者预后结果的影响的疑问。
从开始到 2023 年 7 月，对 PubMed、Embase、Web of Science 和 Cochrane Library 数据库进行了全面检索。目的是确定比较接受手术切除或其他全身治疗的 iCCA 患者中 FGFR2 改变和无 FGFR2 改变组之间预后的相关出版物。使用风险比（HRs）及其 95%置信区间（CIs）来估计主要结局指标，即总生存期（OS）和无病生存期（DFS），并将统计学显著性定义为 p <.05。使用纽卡斯尔-渥太华质量评估量表评估研究质量。使用 Review Manager 5.4 软件和 Stata 版本 12.0 进行统计分析。
纳入了 6 项研究，共纳入 1314 名患者（FGFR2 改变组 n = 173，无 FGFR2 改变组 n = 1141）。分析表明，FGFR2 改变组的 OS 预后明显优于无 FGFR2 改变组，固定效应联合效应量 HR = 1.31，95%CI = 1.001-1.715，p =.049。此外，Meta 回归和亚组分析表明，随访时间的长短并未给结果带来异质性。这一发现表明研究结果的稳定性和可靠性。
本研究提供了有力的证据表明，FGFR2 改变与接受手术切除或其他全身治疗的 iCCA 患者的生存结果改善相关。此外，该研究表明 FGFR2 有望成为治疗转移性、局部晚期或不可切除的 iCCA 的安全可靠的治疗靶点。这项研究为 iCCA 的靶向治疗领域提供了新的视角，为其治疗提供了一种新的创新方法。
