Radiofrequency Ablation versus Hepatic Resection for Small Hepatocellular Carcinomas: A Meta-Analysis of Randomized and Nonrandomized Controlled Trials

Abstract

ObjectivesTo evaluate the efficacy and safety of radiofrequency ablation (RFA) versus hepatic resection (HR) for early hepatocellular carcinoma (HCC) meeting the Milan criteria.MethodsA meta-analysis was conducted, and PubMed, Web of Science, the Cochrane Library, CBM, CNKI and VIP databases were systematically searched through November 2012 for randomized and nonrandomized controlled trials (RCTs and NRCTs). The Cochrane Collaboration's tool and modified MINORS score were applied to assess the quality of RCTs and NRCTs, respectively. The GRADE approach was employed to evaluate the strength of evidence.ResultsThree RCTs and twenty-five NRCTs were included. Among 11,873 patients involved, 6,094 patients were treated with RFA, and 5,779 with HR. The pooled results of RCTs demonstrated no significant difference between groups for 1- and 3-year overall survival (OS), recurrence-free survival (RFS) and disease-free survival (DFS) (p>0.05). The 5-year OS (Relative Risk, RR 0.72, 95% CI 0.60 to 0.88) and RFS (RR 0.56, 95% CI 0.40 to 0.78) were lower with RFA than with HR. The 3- and 5-year recurrences with RFA were higher than with HR (RR 1.48, 95% CI 1.14 to 1.94, and RR 1.52, 95% CI 1.18 to 1.97, respectively), but 1-year recurrence and in-hospital mortality showed no significant differences between groups (p>0.05). The complication rate (RR 0.18, 95% CI 0.06 to 0.53) was lower and hospital stays (Mean difference -8.77, 95% CI −10.36 to −7.18) were shorter with RFA than with HR. The pooled results of NRCTs showed that the RFA group had lower 1-, 3- and 5-year OS, RFS and DFS, and higher recurrence than the HR group (p<0.05). But for patients with very early stage HCC, RFA was comparable to HR for OS and recurrence.ConclusionThe effectiveness of RFA is comparable to HR, with fewer complications but higher recurrence, especially for very early HCC patients.

Propensity score‐matched comparison of non‐anatomical resection and radiofrequency ablation for hepatocellular carcinoma in patients with up to three tumours, each measuring up to 3 cm in diameter

“…A recent meta‐analysis28, including three RCTs11, 12, 13 and several retrospective studies14, 15, 16 comparing RFA with surgical resection, concluded that RFA was comparable to surgical resection in terms of survival, with lower complication rates but higher recurrence rates, consistent with the present results. A study29 comparing RFA with surgical resection for solitary small HCC using a propensity score model showed that surgical resection provided better OS and RFS than RFA.…”

Current management of hepatocellular carcinoma: An Eastern perspective

“…This technique is being applied in several Asian countries with good results [43,44] . Several randomized controlled trials compared the efficacy of RFA with that of resection in Asian patients with HCC meeting the Milan criteria [45,46] . Pooled data demonstrated no significant differences in overall survival or recurrence-free survival between the treatments at 1 and 3 years.…”

“…Pooled data demonstrated no significant differences in overall survival or recurrence-free survival between the treatments at 1 and 3 years. The 5-year overall survival [relative risk (RR), RR = 0.72, 95% confidence interval (CI): 0.60-0.88] and recurrence-free survival (RR = 0.56, 95%CI: 0.40-0.78) rates were higher in the resection group [46] ; however, the 5-year data were provided by only one study, which advocated surgery. Complication rates were lower and hospitalization period shorter in patients who received RFA rather than resection [46] .…”

“…The 5-year overall survival [relative risk (RR), RR = 0.72, 95% confidence interval (CI): 0.60-0.88] and recurrence-free survival (RR = 0.56, 95%CI: 0.40-0.78) rates were higher in the resection group [46] ; however, the 5-year data were provided by only one study, which advocated surgery. Complication rates were lower and hospitalization period shorter in patients who received RFA rather than resection [46] . Although the efficacy of RFA appears to be comparable to that of hepatic resection with lower complication rates, additional data may be significantly better objective response rate with DEB-TACE (85%) than with conventional TACE (30%, P < 0.01) as assessed by modified Response Evaluation Criteria in Solid Tumors.…”

Study on the diagnosis of small hepatocellular carcinoma caused by hepatitis B cirrhosis via multi‑slice spiral CT and MRI

“…Early and timely diagnosis, and surgical resection or interventional therapy could help significantly in improving the patient's survival rate, and prolong their survival time (8). Diagnosis of small HCC is acquired solely by imaging as patients with small HCC have no clinical signs.…”