Korean J Radiol.  2018 Aug;19(4):613-622. 10.3348/kjr.2018.19.4.613.

Radiofrequency Ablation Combined with Transcatheter Arterial Chemoembolization Therapy Versus Surgical Resection for Hepatocellular Carcinoma within the Milan Criteria: A Meta-Analysis

• Wang WD
• Zhang LH
• Ni JY
• Jiang XY
• Chen D
• Chen YT
• Sun HL
• Luo JH
• Xu LF

• KMID: 2413691
• DOI: http://doi.org/10.3348/kjr.2018.19.4.613

Abstract

OBJECTIVE
To meta-analytically compare combined transarterial chemoembolization (TACE) plus radiofrequency ablation (RFA) and surgical resection (SR) for the treatment of hepatocellular carcinoma (HCC) within the Milan criteria.
MATERIALS AND METHODS
PubMed, Medline, Embase, and Cochrane Library were searched for studies comparing these two therapies that were published between January 2006 and August 2017. Overall survival rate (OS), recurrence-free survival rate (RFS), major complications and the average length of hospital stay were compared between these two therapies. Meta-analytic pooled odds ratio (OR) was calculated using TACE plus RFA as the base category.
RESULTS
Seven case-control studies and one randomized trial were identified. Meta-analytic results revealed that, compared with SR, TACE plus RFA had significantly higher 1-year OS (OR for survival = 0.50, p = 0.009) and lower major complications (OR = 1.88, p = 0.02) after therapy. Three studies reported on the length of hospital stay. The average length ± standard deviation reported in individual studies for SR and TACE plus RFA groups was 19.8 ± 8.4 days and 7.4 ± 2.2 days, respectively; 18.7 ± 4.9 days and 11.5 ± 6.9 days, respectively; and 16.6 ± 6.7 days and 8.5 ± 4.1 days, respectively (p < 0.0001 for all studies). Three or 5-year OS and 1-, 3-, or 5-year RFS did not significantly differ between the two therapies.
CONCLUSION
Combined TACE plus RFA may be an alternative to SR for the treatment of patients with HCC within Milan the criteria. Non-randomized design in most of the original studies was a limitation.

Keyword

Radiofrequency ablation; Transarterial chemoembolization; Surgical resection; Hepatocellular carcinoma; Meta-analysis

MeSH Terms

Carcinoma, Hepatocellular*
Case-Control Studies
Catheter Ablation*
Humans
Length of Stay
Odds Ratio
Survival Rate

Figure

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  Fig. 1 Flow diagram of article selection process.HCC = hepatocellular carcinoma, RFA = radiofrequency ablation, SR = surgical resection, TACE = transarterial chemoembolization

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  Fig. 2 Meta-analysis of 1-year OS results.CI = confidence interval, M-H = Mantel-Haenszel, OR = odds ratio, OS = overall survival ratio

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  Fig. 3 Meta-analysis of 3-year OS results.

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  Fig. 4 Meta-analysis of 5-year OS results.

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  Fig. 5 Meta-analysis of 1-year RFS results.RFS = recurrence-free survival rate

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  Fig. 6 Meta-analysis of 3-year RFS results.

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  Fig. 7 Meta-analysis of 5-year RFS results.

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  Fig. 8 Meta-analysis of major complication results.

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