Comparative efficacy and safety of local palliative therapeutics for unresectable malignant biliary obstruction: a Bayesian network meta-analysis

ABSTRACT

Background

Both radiofrequency ablation (RFA), photodynamic therapy (PDT), and biliary stent alone are common local palliative therapies for unresectable malignant biliary obstruction (MBO), but the best modality is uncertain.

Research design and methods

Embase, Cochrane Library, PubMed, and Web of Science were systematically searched up to 30 January 2022, for eligible studies that compared either two or all modalities in unresectable MBO.

Results

Thirty-three studies with 2974 patients were included in this study. The PDT+Stent and RFA+Stent groups had better overall survival and longer mean survival time than Stent alone (all P < 0.05). Moreover, patients with RFA+Stent demonstrated better mean duration of stent patency (MD: 2.0, 95%CI,1.1 to 2.8, P < 0.05) than Stent alone. The three modalities had similar postoperative mild bleeding, cholangitis, and pancreatitis (all P ≥ 0.05). According to network ranking, PDT+Stent was most likely to provide better survival, RFA+Stent was most likely to maintain stent patency.

Conclusions

RFA or PDT plus biliary stent is effective and safe local palliative therapy for unresectable MBO, but the current studies cannot absolutely determine which modality is the best. We should offer patients the most appropriate treatment according to the advantage of each therapy and the patient’s performance status.

KEYWORDS:

• Radiofrequency ablation
• photodynamic therapy
• biliary stent
• unresectable malignant biliary obstruction
• network meta-analysis

Abbreviation

95%CI: 95% confidence interval; CCA: cholangiocarcinoma; HR: Hazard ratio; I²: I-squared; MBO: Malignant biliary obstruction; MCMC: Markov chain Monte Carlo methods; MD: Mean difference; NOS: The Newcastle-Ottawa Scale; OR: Odds ratio; PDT: Photodynamic therapy; PRISMA: Preferred Reporting Items for Systematic Review and Meta-Analysis; RCTs: Randomized controlled trials; RFA: Radiofrequency ablation.

Author contributions

All authors participated in the interpretation of study results and approved the final version of the manuscript. Tiankang Guo and Kehu Yang contributed to studying concepts and design. Shaoming Song, Shiyi Gong and Ting Lei contributed to data collection, statistical analysis, data interpretation, and the paper’s drafting. Hongwei Tian, Tingting Lu, Caining Lei, Haojie Jin, and Wenwen Yang contributed to data collection. All authors agree to be accountable for all aspects of the work.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17474124.2022.2085090

Additional information

Funding

This research is supported by the Fundamental Research Funds for the Central Universities (Grant no. 2020jbkyzx001, lzujbky-2020-kb20); Key Laboratory of Molecular Diagnosis and Precision Therapy of Surgical Tumors of Gansu Province, grant number ‘2019GSZDSYS06’.