Meta-analysis of radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma.

ABSTRACT

BACKGROUND: 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. This study is a meta-analysis of the available evidence. METHODS: Systematic 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. RESULTS: One 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 survival, as reported in three NRCTs .

CONCLUSIONS:

HR 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.