Radiofrequency ablation versus hepatic resection for recurrent hepatocellular carcinoma: an updated meta-analysis
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RESEARCH ARTICLE
Radiofrequency ablation versus hepatic resection for recurrent hepatocellular carcinoma: an updated meta-analysis Daopeng Yang†, Bowen Zhuang†, Yan Wang, Xiaoyan Xie and Xiaohua Xie*
Abstract Background: The clinical benefits of treatment with radiofrequency ablation (RFA) and repeat hepatic resection (RHR) for recurrent hepatocellular carcinoma (RHCC) remain controversial. This meta-analysis aims to evaluate the outcomes and major complications of RFA versus RHR in patients with early-stage RHCC. Methods: PubMed, Embase, Web of Science and the Cochrane Library were systematically searched for comparative studies on the evaluation of RHR versus RFA for RHCC. The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS) and major complications. Meta-analysis was performed using a random-effects model or fixed-effects model, and heterogeneity was tested by the Cochran Q statistic. Results: Ten studies with 1612 patients (RHR = 654, RFA = 958) were included in the meta-analysis. The meta-analysis showed that RHR had superior OS (HR 0.77, 95% CI =0.65–0.92, P = 0.004) and PFS (HR 0.81, 95% CI =0.67–0.98, P = 0.027) compared to RFA, whereas major complications may be less frequent in the RFA group (OR 0.15, 95% CI = 0.06–0.39, P 3 cm and ≤ 5 cm, RFA showed an increased mortality in terms of OS (HR 0.57, 95% CI = 0.37–0.89, P = 0.014). Conclusion: RHR offers a longer OS and PFS than RFA for patients with RHCC, but no statistically significant difference was observed for single RHCC ≤3 cm. The advantages of fewer major complications may render RFA an alternative treatment option for selected patients. Keywords: Hepatocellular carcinoma, Recurrent, Radiofrequency ablation, Hepatic resection, Meta-analysis Background Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third most common cause of cancer-related death worldwide [1]. Although hepatic resection(HR) remains a curative treatment for HCC [2], *Correspondence: [email protected] † Daopeng Yang and Bowen Zhuang contributed equally to this paper and should be considered co-first authors Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun YatSen University, NO.58 Zhongshan Road 2, Guangzhou 510080, People’s Republic of China
the long-term outcomes after resection are not yet satisfactory, as the incidence of tumor recurrence can be up to 60–80% within 5 years [3, 4], and the reported 5-year survival rate of HCC ranges from 40 to 50% [5–7]. Currently, repeat hepatic resection (RHR) and radiofrequency ablation (RFA) are available as the major curative treatments for early-stage recurrent hepatocellular carcinoma (RHCC) [8–10]. RHR is typically considered the first-line treatment for RHCC [7], but its application is limited by more limited liver function reserve and technical difficulties than initial resection [11, 12]. Compared with RHR, RFA has advantages in high repeat applications an
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