Comparison of clinical efficacy between radiofrequency ablation and surgical resection for early hepatocellular carcinoma: a Meta-analysis

Abstract

Objective To compare the clinical efficacy between radiofrequency ablation (RFA) and surgical resection (SR) for early hepatocellular carcinoma (HCC). Methods Open published literatures related to RFA and SR for the treatment of early HCC between January 2004 and February 2017 were searched by computer from PubMed, Embase, Web of science, CNKI and Wanfang databases. The researching keywords in Chinese and English included hepatocellular carcinoma, liver cancer, hepatic carcinoma, liver neoplasms, HCC, radiofrequency ablation, ablative therapy, RFA, surgical resection and hepatectomy. The clinical data including survival rate, incidence of complication and perioperative length of hospital stay of the early HCC patients up to the standard of Milan criteria were extracted for Meta-analysis. Heterogenous studies were analyzed using random effect model, and homogenous studies were analyzed using fixed effect model. Results A total of 20 literatures including 4 randomized control trials and 16 retrospective studies were included in this Meta-analysis. In total, 3 849 patients with early HCC were analyzed. Among the patients, 1 946 cases underwent SR and 1 903 underwent RFA. The postoperative 3-, 5-year overall survival rate of the SR patients was significantly higher than those of the RFA patients (OR=1.09, 1.58; P<0.05). The postoperative 1-, 3-, 5-year tumor-free survival rate of the SR patients was significantly higher than those of the RFA patients (OR=1.88, 2.31, 2.14; P<0.05). The postoperative 1-, 3-, 5-year tumor recurrence rate of the SR patients was significantly lower than those of the RFA patients (OR=0.57, 0.18, 0.46; P<0.05). The incidence of postoperative complications of the SR patients was significantly higher than that of the RFA patients (OR=3.84, P<0.05). The perioperative length of hospital stay of the SR patients was significantly higher than that of the RFA patients (WMD=7.08, P<0.05). Conclusions For early HCC patients up to the standard of Milan criteria, the long-term survival and recurrence of SR are significantly superior to those of RFA. Nevertheless, RFA has the advantages of minimal invasion, low incidence of postoperative complications and short length of hospital stay. Key words: Carcinoma, hepatocellular; Catheter ablation; Hepatectomy; Comparative effectiveness research