Ann Hepatobiliary Pancreat Surg.  2024 Nov;28(4):397-411. 10.14701/ahbps.24-103.

Primary treatments for solitary hepatocellular carcinoma ≤ 3 cm: A systematic review and network meta-analysis

• Kim SH
• Kim KH
• Na BG
• Kim SM
• Oh RK

• KMID: 2561572
• DOI: http://doi.org/10.14701/ahbps.24-103

Abstract

Various treatment modalities are available for small solitary hepatocellular carcinoma (HCC), yet the optimal primary treatment strategy for tumors ≤ 3 cm remains unclear. This network meta-analysis investigates the comparative efficacy of various interventions on the long-term outcomes of patients with solitary HCC ≤ 3 cm. A systematic search of electronic databases from January 2000 to December 2023 was conducted to identify studies that compared at least two of the following treatments: surgical resection (SR), radiofrequency ablation (RFA), microwave ablation (MWA), and transarterial chemoembolization (TACE). Survival data were extracted, and pooled hazard ratios with 95% confidence intervals were calculated using a frequentist network meta-analysis. A total of 30 studies, comprising 2 randomized controlled trials and 28 retrospective studies, involving 8,053 patients were analyzed. Surgical resection showed the highest overall survival benefit with a p-score of 0.95, followed by RFA at 0.59, MWA at 0.23, and TACE, also at 0.23. Moreover, SR provided the most significant recurrence-free survival advantage, with a p-score of 0.95, followed by RFA at 0.31 and MWA at 0.19. Sensitivity analyses, excluding low-quality or retrospective non-matched studies, corroborated these findings. This network meta-analysis demonstrates that SR is the most effective first-line curative treatment for single HCC ≤ 3 cm, followed by RFA in patients with preserved liver function. The limited data on MWA and TACE underscore the need for further studies.

Keyword

Network meta-analysis; Hepatocellular carcinoma; Overall survival; Recurrence-free survival; Treatment

Figure

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  Fig. 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart of study inclusion. HCC, hepatocellular carcinoma.

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  Fig. 2 Meta-analysis of SR vs. RFA. (A) 3-year and 5-year OS. (B) 3-year and 5-year RFS. OS, overall survival; SR, surgical resection; RFA, radiofrequency ablation; RFS, recurrence-free survival; HR, hazard ratio; SE, standard error; CI, confidence interval.

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  Fig. 3 Meta-analysis of SR vs. MWA. (A) 3-year and 5-year OS. (B) 3-year and 5-year RFS. OS, overall survival; SR, surgical resection; MWA, microwave ablation; RFS, recurrence-free survival; HR, hazard ratio; SE, standard error; CI, confidence interval.

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  Fig. 4 Meta-analysis of SR vs. TACE. 3-year and 5-year overall survival. OS, overall survival; SR, surgical resection; TACE, transcatheter arterial hemoembolization; HR, hazard ratio.

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  Fig. 5 Meta-analysis of RFA vs. MWA. (A) 3-year and 5-year OS. (B) 3-year and 5-year RFS. OS, overall survival; RFA, radiofrequency ablation; MWA, microwave ablation; RFS, recurrence-free survival; HR, hazard ratio; SE, standard error; CI, confidence interval.

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  Fig. 6 Meta-analysis of RFA vs. TACE. 3-year and 5-year OS. OS, overall survival; SR, surgical resection; RFA, radiofrequency ablation; TACE, transcatheter arterial hemoembolization; HR, hazard ratio; SE, standard error; CI, confidence interval.

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  Fig. 7 Network meta-analysis for rank of treatments. (A) 5-year OS and (B) 5-year and 5-year RFS. OS, overall survival; SR, surgical resection; RFA, radiofrequency ablation; TACE, transcatheter arterial hemoembolization; MWA, microwave ablation; RFS, recurrence-free survival; HR, hazard ratio; CI, confidence interval.

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  Fig. 8 Comparison-adjusted funnel plot showing no significant publication bias. SR, surgical resection; RFA, radiofrequency ablation; TACE, transcatheter arterial hemoembolization; MWA, microwave ablation; RFS, recurrence-free survival.

Reference

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