Radiofrequency ablation versus hepatic resection for the treatment of early-stage hepatocellular carcinoma meeting Milan criteria: a systematic review and meta-analysis

Chenyang Duan, Mengying Liu, Zhuohang Zhang, Kuansheng Ma, Ping Bie, Chenyang Duan, Mengying Liu, Zhuohang Zhang, Kuansheng Ma, Ping Bie

Abstract

Current options for the treatment of the early-stage HCC conforming to the Milan criteria consist of liver transplantation, hepatic resection (HR), transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) .Whether HR or RFA is the better treatment for early HCC has long been debated. The aim of our paper is to compare the therapeutic effects of radiofrequency ablation (RFA) and hepatic resection (HR) in the treatment of early-stage hepatocellular carcinoma (HCC). Controlled trials evaluating the efficacy between RFA and HR for the treatment of early-stage HCC published before June 2013 were searched electronically using MEDLINE, PubMed, Cochrane Library, and EMBASE databases. Using inclusion and exclusion criteria, two randomized controlled trials and 10 nonrandomized controlled trials were included in the meta- analysis. The results showed that the 3,5-year overall survival rates and 1,3,5 disease-free survival rates were significantly lower after RFA than after HR. However, complications after treatment were less common and the length of hospital stay was significantly shorter after RFA. Additionally, there was no significant difference in the 1-year overall survival rate between RFA and HR. The conclusions of the results show that the difference in the short-term effectiveness of RFA and HR in the treatment of small HCC is not notable, but the long-term efficacy of HR is better than that of RFA. However, HR is associated with more complications and a longer hospital stay.

Figures

Figure 1
Figure 1
Process of study selection. NRCT, nonrandomized controlled trial; RCT, randomized controlled trial.
Figure 2
Figure 2
Comparison of the 1-year overall survival rate between radiofrequency ablation (RFA) and hepatic resection (HR). CI, confidence interval; M-H, Mantel-Haenszel.
Figure 3
Figure 3
Comparison of the 3-year overall survival rate between radiofrequency ablation (RFA) and hepatic resection (HR). CI, confidence interval; M-H, Mantel-Haenszel.
Figure 4
Figure 4
Comparison of the 5-year overall survival rate between radiofrequency ablation (RFA) and hepatic resection (HR). CI, confidence interval; M-H, Mantel-Haenszel.
Figure 5
Figure 5
Comparison of the 1-year disease-free survival rate between radiofrequency ablation (RFA) and hepatic resection (HR). CI, confidence interval; M-H, Mantel-Haenszel.
Figure 6
Figure 6
Comparison of the 3-year disease-free survival rate between radiofrequency ablation (RFA) and hepatic resection (HR). CI, confidence interval; M-H, Mantel-Haenszel.
Figure 7
Figure 7
Comparison of the 5-year disease-free survival rate between radiofrequency ablation (RFA) and hepatic resection (HR). CI, confidence interval; M-H, Mantel-Haenszel.
Figure 8
Figure 8
Comparison of the number of complications between radiofrequency ablation (RFA) and hepatic resection (HR). CI, confidence interval; M-H, Mantel-Haenszel.
Figure 9
Figure 9
Comparison of the length of hospital stay between radiofrequency ablation (RFA) and hepatic resection (HR). CI, confidence interval; M-H, Mantel-Haenszel.
Figure 10
Figure 10
Funnel plot for each comparison. (A) 1-year overall survival rate; (B) 3-year overall survival rate; (C) 5-year overall survival rate; (D) 1-year disease-free survival rate; (E) 3-year disease-free survival rate; (F) 5-year disease-free survival rate; (G) complications after treatment; (H) hospital stay. OR, odds ratio.

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