Overall survival and local recurrence following RFA, MWA, and cryoablation of very early and early HCC: a systematic review and Bayesian network meta-analysis.

ABSTRACT

OBJECTIVE: To compare overall survival (OS) and local recurrence (LR) following radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) for very early and early hepatocellular carcinoma (HCC). METHODS: This systematic review was performed according to the PRISMA guidelines. MEDLINE, Embase, and Cochrane databases were searched. Randomized controlled trials (RCTs) and observational studies were included. OS and LR at 1 year and 3 years were assessed. OS was reported as hazard ratio (HR) with 95% credible intervals (CrI) and LR as relative risk (RR) with 95% CrI, to summarize effect of each comparison. RESULTS: Nineteen studies (3043 patients), including six RCTs and 13 observational studies, met inclusion criteria. For OS at 1 year, as compared to RFA, CA had HR of 0.81 (95% CrI 0.43-1.51), and MWA had HR of 1.01 (95% CrI 0.71-1.43). For OS at 3 years, as compared to RFA, CA had HR of 0.90 (95% CrI 0.48-1.64) and MWA had HR of 1.07 (95% CrI 0.73-1.50). For LR at 1 year, CA and MWA had RR of 0.75 (95% CrI 0.45-1.24) and 0.93 (95% CrI 0.78-1.14), respectively, as compared to RFA. For LR at 3 years, CA and MWA had RR of 0.96 (0.74-1.23) and 0.98 (0.87-1.09), respectively, as compared to RFA. Overall, none of the comparisons was statistically significant. Age of patients and tumor size did not influence treatment effect. CONCLUSIONS: RFA, MWA, and CA are equally effective for locoregional treatment of very early and early HCC. KEY POINTS • There is no significant difference in the OS and LR (at 1 year and 3 years) following ablation of very early and early HCC with RFA, MWA, and CA. • There was no effect of tumor size on the treatment efficacy. • More RCTs comparing CA with RFA and MWA should be performed.