Resection or radiofrequency ablation for hepatocellular carcinoma? Assessment of validity of current studies, meta-analyses and their influence on guidelines.
HPB (Oxford)
; 22(8): 1206-1215, 2020 08.
Article
en En
| MEDLINE
| ID: mdl-31959487
ABSTRACT
BACKGROUND:
Two Cochrane reviews compared overall survival following liver resection (LR) or radiofrequency ablation (RFA) for patients with hepatocellular carcinoma. The first from 2013, found moderate evidence for a survival advantage for LR over RFA when limiting the analysis to trials at low risk of bias. The second (2017), found no evidence for a difference in all-cause mortality for LR versus RFA. Aim was to assess the validity of the randomized controlled trials included in both Cochrane reviews and to investigate their impact on current guidelines.METHODS:
The validity of the studies was analyzed using the CONSORT checklist. Two meta-analyses were then performed with all eligible studies from both meta-analyses. Finally, the impact of the result of the original meta-analyses on eight international guidelines was assessed.RESULTS:
The four randomized controlled trials showed several inconsistencies (unclear or inadequate randomization, absence of sample-size calculation, missing blinded setup and/or conflicts of interest). All guidelines used recommendations based on the results of the meta-analyses or on studies included in the meta-analyses.CONCLUSION:
The analyzed studies showed a substantial lack of overall validity. However the results of these studies and subsequent meta-analyses are used as the evidence base for the majority of current guidelines.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Ablación por Catéter
/
Carcinoma Hepatocelular
/
Ablación por Radiofrecuencia
/
Neoplasias Hepáticas
Tipo de estudio:
Clinical_trials
/
Guideline
/
Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
HPB (Oxford)
Asunto de la revista:
GASTROENTEROLOGIA
Año:
2020
Tipo del documento:
Article