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

Yingqiang Wang,Shaolin Deng,Shiyou Wei,Youping Li,Qianqian Luo,Xianglian Li,Yujin Hoshida

doi:10.1371/journal.pone.0084484

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.

Highlights

Cancer is a major component of the global burden of disease (GBD)
The pooled meta-analysis of the Randomized controlled trials (RCTs) demonstrated no significant difference between groups of the overall survival, recurrence-free survival, disease-free survival and in-hospital mortality rates for early hepatocellular carcinoma (HCC) with tumor size smaller than 5 cm in diameter, but the radiofrequency ablation (RFA) group had higher recurrence rates, lower complication rates, and shorter hospital lengths of stay
The pooled meta-analysis of the nonrandomized controlled trials (NRCTs) showed no significant difference in recurrence rates between groups for patients with Child-Pugh class A or tumor size smaller than 3 cm or 3 cm to 5 cm in diameter

Summary

Introduction

There were 2.49 billion disability-adjusted life years (DALYs), or 361 DALYs per 1000 population worldwide in 2010[1], and all neoplasms accounted for 7.6% (189 million DALYs) of global DALYs, an increase of 20 million DALYs (11.8%) compared with 2008[1,2]. There were 19.1 million DALYs for liver cancer in 2010, which accounted for 0.8% of the GBD or 10.1% of the DALYS for all neoplasms [1]. Hepatic resection (HR) and liver transplantation (LT) were recommended by the latest guidelines for early hepatocellular carcinoma meeting the Milan criteria, with the 5-year survival rate potentially reaching 50 to 75% [4,5]. Only 20–35% of patients are suitable for liver resection because of the low diagnosis rate for early HCC and to poor liver function [6]. Few patients can be treated with liver transplantation because of the strict inclusion criteria, high cost, and limited donor liver resources

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