The online version of this article (doi:10.1186/1477-7819-10-163) contains supplementary material, which is available to authorized users.
Gang Xu, Fu-zhen Qi contributed equally to this work.
The authors declare that they have no competing interests.
XG, QFZ, and MY designed the studyand wrote the manuscript.XG, QFZ, ZJH, CGF, and CY performed data acquisition.MY performed quality control of data.XG, QFZ, and MY performed statistical analysis and interpretation. All authors read and approved the final manuscript. XG and QFZ contributed equally to this work.
There is no definite agreement on the better therapy (radiofrequency ablation (RFA) versus surgical resection (SR)) for early hepatocellular carcinoma (HCC) eligible for surgical treatments. The purpose of this study is to evaluate the evidence using meta-analytical techniques.
A literature search was undertaken until December 2011 to identify comparative studies evaluating survival rates, recurrence rates, and complications. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated with either the fixed or random effect model.
Thirteen articles, comprising two randomized controlled trials(RCTs), were included in the review, with a total of 2,535 patients (1,233 treated with SR and 1,302 with RFA). The overall survival rates were significantly higher in patients treated with SR than RFA after1, 3, and 5 years (respectively: OR, 0.60 (95% CI, 0.42 to 0.86); OR, 0.49 (95% CI, 0.36 to 0.65); OR, 0.60 (95% CI, 0.43 to 0.84)). In the SR group, the 1, 3, and 5 years recurrence rates were significantly lower than the RFA group (respectively: OR, 1.48 (95% CI, 1.05 to 2.08); OR, 1.76 (95% CI, 1.49 to 2.08); OR, 1.68 (95% CI, 1.21 to 2.34)). However, local recurrence between two groups did not exhibit significant difference. For HCC ≤ 3 cm in diameter, SR was better than RFA at the 1, 3, and 5 years overall survival rates (respectively: OR, 0.34 (95% CI, 0.13 to 0.89); OR, 0.56 (95% CI, 0.37 to 0.84); OR, 0.44 (95% CI, 0.31 to 0.62)). This meta-analysis indicated that the complication of SR was higher than RFA (OR, 6.25 (95%CI, 3.12 to 12.52); P = 0.000).
Although local recurrence between two groups did not exhibit significant difference, SR demonstrated significantly improved survival benefits and lower complications for patients with early HCC, especially for HCC ≤ 3 cm in diameter. These findings should be interpreted carefully, owing to the lower level of evidence.
Yang JD, Roberts LR: Hepatocellular carcinoma: aglobal view. Nat Rev GastroenterolHepatol. 2010, 7: 448-458. CrossRef
Benson AB, Abrams TA, Ben-Josef E, Bloomston PM, Botha JF, Clary BM, Covey A, Curley SA, D’Angelica MI, Davila R, Ensminger WD, Gibbs JF, Laheru D, Malafa MP, Marrero J, Meranz SG, Mulvihill SJ, Park JO, Posey JA, Sachdev J, Salem R, Sigurdson ER, Sofocleous C, Vauthey JN, Venook AP, Goff LW, Yen Y, Zhu AX: NCCN clinical practice guidelines in oncology: hepatobiliarycancers. JNatlComprCancNetw. 2009, 7: 350-391.
Zhang YY, Xia HH: Novel therapeutic approaches for hepatocellular carcinoma: fact and fiction. World J of Gastroenterol. 2008, 14: 1641-1642. 10.3748/wjg.14.1641. CrossRef
Lee KK, Kim DG, Moon IS, Lee MD, Park JH: Liver transplantation versus liver resection for the treatment of hepatocellular carcinoma. JSurgOncol. 2010, 101: 47-53.
Sotiropoulos GC, Druhe N, Sgourakis G, Molmenti EP, Beckebaum S, Baba HA, Antoch G, Hilgard P, Radtke A, Saner FH, Nadalin S, Paul A, Malagó M, Broelsch CE, Lang H: Liver transplantation, liver resection, and transarterial chemoembolization for hepatocellular carcinoma in cirrhosis: which is the best oncological approach?. Dig Dis Sci. 2009, 54: 2264-2273. 10.1007/s10620-008-0604-4. CrossRefPubMed
Hasegawa K, Kokudo N, Makuuchi M: Surgical management of hepatocellular carcinoma. Liver resection and liver transplantation. Saudi Med J. 2007, 28: 1171-1179. PubMed
Zhou J, Wang Z, Qiu SJ, Huang XW, Sun J, Gu W, Fan J: Surgical treatment for early hepatocellular carcinoma: comparison of resection and liver transplantation. J Cancer Res ClinOncol. 2010, 136: 1453-1460. 10.1007/s00432-010-0802-2. CrossRef
Peng ZW, Zhang YJ, Chen MS, Lin XJ, Liang HH, Shi M: Radiofrequency ablation as first-line treatment for small solitary hepatocellular carcinoma: long-term results. Eur J SurgOncol. 2010, 36: 1054-1060. CrossRef
Huang J, Yan L, Cheng Z, Wu H, Du L, Wang J, Xu Y, Zeng Y: A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. AnnSurg. 2010, 252: 903-912.
Takayama T, Makuuchi M, Hasegawa K: Single HCC smaller than 2 cm: surgery or ablation?: surgeon’s perspective. JHepatobiliaryPancreatSci. 2010, 17: 422-424.
Chen MS, Li JQ, Zheng Y, Guo RP, Liang HH, Zhang YQ, Lin XJ, Lau WY: A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. AnnSurg. 2006, 243: 321-328.
Hong SN, Lee SY, Choi MS, Lee JH, Koh KC, Paik SW, Yoo BC, Rhee JC, Choi D, Lim HK, Lee KW, Joh JW: Comparing the outcomes of radiofrequency ablation and surgery in patients with a single small hepatocellular carcinoma and well-preserved hepatic function. JClinGastroenterol. 2005, 39: 247-252.
Vivarelli M, Guglielmi A, Ruzzenente A, Cucchetti A, Bellusci R, Cordiano C, Cavallari A: Surgical resection versus percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma on cirrhotic liver. AnnSurg. 2004, 240: 102-107.
Montorsi M, Santambrogio R, Bianchi P, Donadon M, Moroni E, Spinelli A, Costa M: Survival and recurrences after hepatic resection or radiofrequency for hepatocellular carcinoma in cirrhotic patients: a multivariate analysis. JGastrointestSurg. 2005, 9: 62-67.
Nishikawa H, Inuzuka T, Takeda H, Nakajima J, Matsuda F, Sakamoto A, Henmi S, Hatamaru K, Ishikawa T, Saito S, Nasu A, Kita R, Kimuar T, Arimoto A, Osaki Y: Comparison of percutaneous radiofrequency thermal ablation and surgical resection for small hepatocellular carcinoma. BMCgastroenterol. 2011, 11: 143-
Hiraoka A, Horiike N, Yamashita Y, Koizumi Y, Doi K, Yamamoto Y, Hasebe A, Ichikawa S, Yano M, Miyamoto Y, Ninomiya T, Otomi Y, Kokame M, Iwamura T, Ishimaru Y, Sogabe I, Kashihara K, Nishiura S, Ootani H, Takamura K, Kawasaki H: Efficacy of radiofrequency ablation therapy compared to surgical resection in 164 patients in Japan with single hepatocellular carcinoma smaller than 3 cm, along with report of complications. Hepato-gastroenterology. 2008, 55: 2171-2174. PubMed
Takahashi S, Kudo M, Chung H, Inoue T, Nagashima M, Kitai S, Tatsumi C, Minami Y, Ueshima K, Fukunaga T, Haji S: Outcomes of nontransplant potentially curative therapy for early-stage hepatocellular carcinoma in Child-Pugh stage A cirrhosis is comparable with liver transplantation. Dig Dis. 2007, 25: 303-309. 10.1159/000106909. CrossRefPubMed
Guglielmi A, Ruzzenente A, Valdegamberi A, Pachera S, Campagnaro T, D’Onofrio M, Martone E, Nicoli P, Iacono C: Radiofrequency ablation versus surgical resection for the treatment of hepatocellular carcinoma in cirrhosis. JGastrointestSrug. 2008, 12: 192-198.
Nanashima A, Tobinaga S, Masuda J, Miyaaki H, Taura N, Takeshita H, Hidaka S, Sawai T, Nakao K, Nagayasu T: Selecting treatment for hepatocellular carcinoma based on the results of hepatic resection and local ablation therapy. JSurgOncol. 2010, 101: 481-485.
Ueno S, Sakoda M, Kubo F, Hiwatashi K, Tateno T, Baba Y, Hasegawa S, Tsubouchi H: Surgical resection versus radiofrequency ablation for small hepatocellular carcinomas within the Milan criteria. JHepatobiliary Pancreatic Surg. 2009, 16: 359-366. 10.1007/s00534-009-0069-7. CrossRef
Abu-Hilal M, Primrose JN, Casaril A, McPhail MJ, Pearce NW, Nicoli N: Surgical resection versus radiofrequency ablation in the treatment of small unifocal hepatocellular carcinoma. JGastrointestSurg. 2008, 12: 1521-1526.
Hung HH, Chiou YY, Hsia CY, Su CW, Chou YH, Chiang JH, Kao WY, Huo TI, Huang YH, Su YH, Lin HC, Lee SD, Wu JC: Survival rates are comparable after radiofrequency ablation or surgery in patients with small hepatocellular carcinomas. ClinGastroenterolHepatol. 2011, 9: 79-86.
Tashiro H, Aikata H, Waki K, Amano H, Oshita A, Kobayashi T, Tanimoto Y, Kuroda S, Tazawa H, Chayama K: Treatment strategy for early hepatocellular carcinomas: comparison of radiofrequency ablation with or without transcatheter arterial chemoembolization and surgical resection. JSurgOncol. 2011, 104: 3-9.
Rahbari NN, Mehrabi A, Mollberg NM, Muller SA, Koch M, Buchler MW, Weitz J: Hepatocellular carcinoma: current management and perspectives for the future. AnnSurg. 2011, 253: 453-469.
Chen WT, Fernandes ML, Lin CC, Lin SM: Delay in treatment of early-stage hepatocellular carcinoma using radiofrequency ablation may impact survival of cirrhotic patients in a surveillance program. JSurgOncol. 2011, 103: 133-139.
Wong GL, Wong VW, Tan GM, Ip KI, Lai WK, Li YW, Mak MS, Lai PB, Sung JJ, Chan HL: Surveillance programme for hepatocellular carcinoma improves the survival of patients with chronic viral hepatitis. LiverInt. 2008, 28: 79-87. CrossRef
Blum HE, Spangenberg HC: Hepatocellular carcinoma: an update. Arch Iran Med. 2007, 10: 361-371. PubMed
Grat M, Holowko W, Grzegorczyk K, Skalski M, Krawczyk M: Long-term results of liver resection in the treatment of patients with hepatocellular carcinoma. PolPrzeglChir. 2011, 83: 319-324.
Ohashi M, Wakai T, Korita PV, Ajioka Y, Shirai Y, Hatakeyama K: Histological evaluation of intracapsular venous invasion for discrimination between portal and hepatic venous invasion in hepatocellular carcinoma. JGastroenterolHepatol. 2010, 25: 143-149.
Park YN: Pathology of hepatocellular carcinoma: recent update. Korean J Gastroenterol. 2005, 45: 227-233. PubMed
Rossi S, Ravetta V, Rosa L, Ghittoni G, Viera FT, Garbagnati F, Silini EM, Dionigi P, Calliada F, Quaretti P, Tinelli C: Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: a long-term cohort study. Hepatology. 2011, 53: 136-147. 10.1002/hep.23965. CrossRefPubMed
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