Abstract
BackgroundThere is no clear consensus on the better therapy [radiofrequency ablation (RFA) versus hepatic resection (HR)] for small hepatocellular carcinoma (HCC) eligible for surgical treatments. This study is a meta-analysis of the available evidence.MethodsSystematic review and meta-analysis of trials comparing RFA with HR for small HCC published from 1997 to 2009 in PubMed and Medline. Pooled odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using either the fixed effects model or random effects model.ResultsOne randomized controlled trial, and 9 nonrandomized controlled trials studies were included in this analysis. These studies included a total of 1411 patients: 744 treated with RFA and 667 treated with HR. The overall survival was significantly higher in patients treated with HR than in those treated with RFA at 3 years (OR: 0.56, 95% CI: 0.44-0.71), and at 5 year (OR: 0.60, 95% CI: 0.36-1.01). RFA has a higher rates of local intrahepatic recurrence compared to HR (OR: 4.50, 95% CI: 2.45-8.27). In the HR group the 1, 3, and 5 years disease -free survival rates were significantly better than in the HR-treated patients (respectively: OR: 0.54, 95% CI: 0.35-0.84; OR: 0.44, 95% CI: 0.28-0.68; OR: 0.64, 95% CI: 0.42-0.99). The postoperative morbidity was higher with HR (OR: 0.29, 95% CI: 0.13-0.65), but no significant differences were found concerning mortality. For tumors ≤ 3 cm HR did not differ significantly from RFA for survival, as reported in three NRCTs .ConclusionsHR was superior to RFA in the treatment of patients with small HCC eligible for surgical treatments, particularly for tumors > 3 cm. However, the findings have to be carefully interpreted due to the lower level of evidence.
Highlights
There is no clear consensus on the better therapy [radiofrequency ablation (RFA) versus hepatic resection (HR)] for small hepatocellular carcinoma (HCC) eligible for surgical treatments
RFA was recommended as the best treatment option for patients with early stage HCC who are not suitable for resection or transplantation in addition to percutaneous ethanol injection (PEI) in the 2005 practice guidelines issued by the American Association for the Study of Liver Diseases [9]
Three trials were excluded from the analysis, as no information concerning 3 or 5-year overall survival was provided in these trials [18,19,20]
Summary
There is no clear consensus on the better therapy [radiofrequency ablation (RFA) versus hepatic resection (HR)] for small hepatocellular carcinoma (HCC) eligible for surgical treatments. Liver transplantation, which offers the potential to both resect the entire potentially tumor-bearing liver and eliminate the cirrhosis, achieves the best results but can be offered only to a minority of patients because of the. Among these therapies, RFA is a promising and recently developed ablation technique. A meta-analysis of randomized controlled trial (RCT) showed that RFA ablation is superior to PEI in the treatment of patients with relatively preserved liver function and early-stage non-surgical HCC with respect to survival and local control of the disease [10].
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