Journal
JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES
Volume 29, Issue 6, Pages 693-702Publisher
WILEY
DOI: 10.1002/jhbp.960
Keywords
endoscopic retrograde cholangiopancreatography; malignant biliary stricture; overall survival; propensity score matching; radiofrequency ablation
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Funding
- Shanghai Outstanding Medical Academic Leader Program [2015-83]
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This study investigated the long-term outcomes of endoscopic radiofrequency ablation (RFA) for malignant biliary strictures in a large cohort of patients. Results showed that RFA could prolong overall survival for some patients, but the survival benefits were limited to patients with extrahepatic cholangiocarcinoma without distant metastasis.
Background and Aims 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. Methods 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). Results 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). Conclusions The survival benefits of endoscopic RFA appear to be limited to patients with extrahepatic cholangiocarcinoma without distant metastasis.
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