Background
Methods
Search strategy
Study selection
Data extraction
Study outcomes
Risk of bias assessment
Data synthesis and statistical methods
Results
First author | Year | Study design | Region | Population | Arm 1 | Arm 2 | Arm 3 | MWA approach | Patients (N) | Age (years) | Male (%) | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
MWA | HR | MWA + HR | |||||||||||
Xu, J [23] | 2015 | RCT | China | HCC | MWA | HR | – | Percutaneous | 45 | 45 | – | 58.1 | 73 |
Tanaka, K [4] | 2006 | Retrospective cohort | Japan | Metastases | – | HR | MWA + HR | – | – | 37 | 16 | 60.3 | 62 |
Wang, ZL [24] | 2008 | Retrospective cohort | China | HCC | MWA | HR | – | Percutaneous | 114 | 80 | – | 56.0 | 88 |
Imura, S [11] | 2012 | Prospective cohort | Japan | HCC | – | HR | MWA + HR | – | – | 10 | 12 | 65.6 | 68 |
Stattner, S [3] | 2013 | Retrospective cohort | UK | Metastases | MWA | – | MWA + HR | Open | 15 | – | 28 | 66.1 | 74 |
Takami, Y [25] | 2013 | Prospective cohort | Japan | HCC | MWA | HR | – | Thoracotomy, laparoscopy, or laparotomy | 390 | 34 | – | 67.5 | 62 |
Shi, J [26] | 2014 | Retrospective cohort | China | HCC | MWA | HR | – | NR | 117 | 107 | – | 55.6 | 80 |
Tan, K [12] | 2014 | Retrospective cohort | China | Metastases/ HCC* | – | HR | MWA + HR | – | – | 62 | 66 | 50.3 | 84 |
Zhang, EL [6] | 2016 | Retrospective cohort | China | HCC | MWA | HR | – | Percutaneous | 68 | 122 | – | 51.6 | 88 |
Li, W [27] | 2017 | Retrospective cohort | China | HCC | MWA | HR | – | Percutaneous, laparoscopic, and open | 60 | 220 | – | 62.5 | 82 |
Philips, P [13] | 2017 | Retrospective cohort | USA | Metastases/ HCC* | MWA | HR | MWA + HR | Laparoscopic and open | 108 | 84 | 84 | 61.0 | 55 |
Ryu, T [7] | 2017 | Retrospective cohort | Japan | Metastases | MWA | HR | MWA + HR | Open | 13 | 14 | 7 | 66.0 | 71 |
Song, P [14] | 2017 | Retrospective cohort | China | Metastases | MWA | HR | – | Percutaneous† | 28 | 34 | – | 60.0 | 53 |
Zhang, QB [15] | 2017 | Retrospective cohort | China | HCC | MWA | HR | – | Percutaneous | 31 | 42 | – | 53.2 | 67 |
Chen, ZB [16] | 2018 | Retrospective cohort | China | HCC | – | HR | MWA + HR | – | – | 191 | 112 | 51.6 | 73 |
Chong, CCN [17] | 2018 | Retrospective cohort | China | HCC | MWA | HR | – | Percutaneous, laparoscopic, and open | 63 | 63 | – | 63.8 | 71 |
Quality assessment
RCT
Observational studies
Analysis
Primary outcome (LTR)
Outcome | Number of studies included in meta-analysis | Summary effect* (95% CI); P value | Heterogeneity (I2 value) (%) |
---|---|---|---|
Primary outcome | |||
LTR | 8 |
2.49 (1.19, 5.22); P = 0.016
| 84 |
Secondary outcomes | |||
OS (1-year) | 10 | 1.01 (0.99, 1.03); P = 0.409 | 0 |
OS (3-year) | 10 |
0.94 (0.88, 0.99); P = 0.03
| 0 |
OS (5-year) | 9 |
0.88 (0.80, 0.97); P = 0.01
| 0 |
IDL | 5 | 1.13 (0.80, 1.60); P = 0.474 | 75 |
EHM | 2 | 1.10 (0.71, 1.72); P = 0.659 | 0 |
Operative time (min) | 3 |
− 58.69 (− 89.55, − 27.83); P < 0.001
| 94 |
Intraoperative blood loss (mL) | 3 |
− 189.09 (− 324.54, − 53.64); P = 0.006
| 93 |
Hospital length of stay (days) | 6 |
− 6.16 (− 8.25, − 4.07); P < 0.001
| 84 |
DFS (1-year) | 8 | 0.95 (0.90, 1.01); P = 0.085 | 39 |
DFS (3-year) | 8 |
0.78 (0.65, 0.94); P = 0.009
| 59 |
DFS (5-year) | 8 | 0.83 (0.58, 1.17); P = 0.284 | 71 |
Overall complications | 9 |
0.31 (0.19, 0.51); P < 0.001
| 10 |
Major complications | 4 |
0.24 (0.10, 0.61); P = 0.002
| 0 |
Minor complications | 3 |
0.45 (0.23, 0.90); P = 0.024
| 66 |
Secondary outcomes
OS
Outcome | Number of studies included in meta-analysis* | Summary effect† (95% CI); P value | Heterogeneity (I2 value) (%) |
---|---|---|---|
Primary outcome | |||
LTR | 3 | 0.63 (0.28, 1.41); P = 0.263 | 69 |
Secondary outcomes | |||
OS (1-year) | 4 | 0.99 (0.88, 1.11); P = 0.867 | 48 |
OS (3-year) | 4 | 0.84 (0.49, 1.46); P = 0.541 | 82 |
OS (5-year) | 2 | 0.74 (0.19, 2.79); P = 0.651 | 91 |
IDL | 2 | 1.08 (0.61, 1.9); P = 0.793 | 51 |
EHM† | 2 | 0.82 (0.49, 1.39); P = 0.464 | 27 |
Operative time (min) | 4 | 13.93 (− 9.69, 37.54); P = 0.248 | 81 |
Intraoperative blood loss (mL) | 4 |
− 161.89 (− 291.49, − 32.30); P = 0.014
| 92 |
Hospital length of stay (days) | 2 | 0.08 (− 2.04, 2.19); P = 0.942 | 0 |
DFS (1-year) | 3 | 0.95 (0.65, 1.40); P = 0.80 | 82 |
DFS (3-year) | 3 | 1.01 (0.69, 1.48); P = 0.944 | 51 |
Overall complications | 5 | 0.86 (0.63, 1.18); P = 0.353 | 0 |
Major complications | 4 | 0.89 (0.57, 1.38); P = 0.588 | 12 |
Minor complications | 3 | 0.83 (0.64, 1.08); P = 0.174 | 0 |
Blood transfusion | 3 | 0.45 (0.14, 1.41); P = 0.171 | 85 |
Outcome | Number of studies included in meta-analysis | Summary effect* (95% CI); P value | Heterogeneity (I2 value) (%) |
---|---|---|---|
Primary outcome | |||
LTR | 2 | 1.66 (0.32, 8.66); P = 0.103 | 62 |
Secondary outcomes | |||
OS (1-year) | 3 | 1.04 (0.93, 1.17); P = 0.495 | 0 |
OS (3-year) | 3 | 1.24 (0.81, 1.89); P = 0.322 | 11 |
Length of hospital stay (days) | 2 | − 1.98 (− 7.86, 3.90); P = 0.508 | 94 |
DFS (1-year) | 2 | 0.78 (0.31, 1.94); P = 0.59 | 66 |
DFS (3-year) | 2 | 0.59 (0.18, 1.91); P = 0.383 | 43 |
Overall complications | 3 |
0.39 (0.18, 0.85); P = 0.018
| 20 |
Major complications | 2 |
0.24 (0.09, 0.60); P = 0.002
| 0 |
IDL and EHM
Operative time
Intraoperative blood loss
LOS
DFS
Overall, major, and minor complications
Blood transfusion
Subgroup analyses
Tumor size (< 3 cm versus ≥ 3 cm)
Subgroup | LTR [RR (95% CI); P value; studies (N); I2] | OS (1-year) [RR (95% CI); P value; studies (N); I2] | Complications [RR (95% CI); P value; studies (N); I2] |
---|---|---|---|
Tumor size | |||
< 3 cm |
2.93 (1.26, 6.81); P = 0.013; 4; 64%
| 1.01 (0.99, 1.04); P = 0.41; 3; 0% | 0.57 (0.06, 5.05); P = 0.615; 3; 67% |
≥ 3 cm | 1.24 (0.53, 2.88); P = 0.624; 2; 62% | 0.96 (0.88, 1.04); P = 0.329; 3; 0% |
0.30 (0.14, 0.64); P = 0.002; 2; 0%
|
Type of tumor | |||
HCC |
3.04 (1.84, 5.02); P < 0.001; 7; 32%
| 1.01 (0.99, 1.03); P = 0.311; 7; 0% |
0.36 (0.19, 0.66); P = 0.001; 6; 21%
|
Liver metastases | Too few studies (< 2) to inform | 0.96 (0.88, 1.06); P = 0.451; 3; 0% |
0.22 (0.09, 0.56); P = 0.001; 2; 0%
|
MWA frequency | |||
2450 MHz |
2.35 (1.49, 3.70); P < 0.001; 6; 0%
| 1.00 (0.98, 1.03); P = 0.766; 8; 0% |
0.35 (0.18, 0.68); P = 0.002; 6; 31%
|
915 MHz | 2.44 (0.31, 19.10); P = 0.396; 2; 96% | 0.98 (0.84, 1.14); P = 0.77; 2; 83% |
0.24 (0.10, 0.61); P = 0.002; 2; 0%
|
Type of tumor (HCC versus metastases)
MWA frequency (915 versus 2450 MHz)
Sensitivity analyses
Main analysis [RR (95% CI); P value; studies (N); I2] | Fixed effects [RR (95% CI); P value; studies (N); I2] | Exclusion of poor quality studies [RR (95% CI); P value; studies (N); I2] | Exclusion of studies with imputed data [RR (95% CI); P value; studies (N); I2] | |
---|---|---|---|---|
LTR |
2.49 (1.19, 5.22); P = 0.016; 8; 84%
|
1.56 (1.28, 1.90); P < 0.001; 8; 84%
|
2.01 (1.06, 3.84); P = 0.033; 7; 72%
| NA |
OS (1-year) | 1.01 (0.99, 1.03); P = 0.409; 10; 0% | 1.00 (0.97, 1.03); P = 0.977; 10; 0% | 1.00 (0.97, 1.03); P = 0.992; 9; 0% | NA |
OS (3-year) |
0.94 (0.88, 0.99); P = 0.03; 10; 0%
|
0.92 (0.86, 0.99); P = 0.016; 10; 0%
| 0.94 (0.88, 1.00); P = 0.061; 9; 0% | NA |
OS (5-year) |
0.88 (0.80, 0.97); P = 0.01; 9; 0%
|
0.87 (0.79, 0.96); P = 0.008; 9; 0%
|
0.88 (0.79, 0.98); P = 0.025; 8; 0%
| NA |
IDL | 1.13 (0.80, 1.60); P = 0.474; 5; 75% | 1.12 (0.95, 1.33); P = 0.17; 5; 75% | 1.14 (0.74, 1.76); P = 0.544; 4; 81% | NA |
EHM | 1.10 (0.71, 1.72); P = 0.659; 2; 0% | 1.09 (0.70, 1.69); P = 0.71; 2; 0% | Too few studies (< 2) to inform | NA |
Operative time (min)* |
− 58.69 (− 89.55, − 27.83); P < 0.001; 3; 94%
|
− 67.99 (− 74.36, − 61.61); P < 0.001; 3; 94%
|
− 44.61 (− 63.74, − 25.49); P < 0.001; 2; 49%
|
− 58.89 (− 100.15, − 17.63); P = 0.005; 2; 97%
|
IBL (mL)* |
− 189.09 (− 324.54, − 53.64); P = 0.006; 3; 93%
|
− 119.88 (− 146.57, − 91.19); P < 0.001; 3; 93%
|
− 189.09 (− 324.54, − 53.64); P = 0.006; 3; 93%
| − 229.28 (− 512.69, 54.12); P = 0.113; 2; 97% |
LOS (days)* |
− 6.16 (− 8.25, − 4.07); P < 0.001; 6; 84%
|
− 7.13 (− 7.78, − 6.48); P < 0.001; 6; 84%
|
− 6.14 (− 8.60, − 3.68); P < 0.001; 5; 87%
|
− 6.5 (− 9.52, − 3.48); P < 0.001; 4; 88%
|
DFS (1-year) | 0.95 (0.90, 1.01); P = 0.085; 8; 39% |
0.94 (0.89, 0.99); P = 0.016; 8; 39%
| 0.95 (0.90, 1.01); P = 0.085; 8; 39% | NA |
DFS (3-year) |
0.78 (0.65, 0.94); P = 0.009; 8; 59%
|
0.76 (0.68, 0.85); P < 0.001; 8; 59%
|
0.78 (0.65, 0.94); P = 0.009; 8; 59%
| NA |
DFS (5-year) | 0.83 (0.58, 1.17); P = 0.284; 8; 71% |
0.79 (0.66, 0.95); P = 0.011; 8; 71%
| 0.83 (0.58, 1.17); P = 0.284; 8; 71% | NA |
Overall complications |
0.31 (0.19, 0.51); P < 0.001; 9; 10%
|
0.33 (0.21, 0.50); P < 0.001; 9; 10%
|
0.32 (0.19,0.55); P < 0.001; 8; 19%
| NA |
Major complications |
0.24 (0.10, 0.61); P = 0.002; 4; 0%
|
0.23 (0.09, 0.59); P = 0.002; 4; 0%
| Too few studies (< 2) to inform | NA |
Minor complications |
0.45 (0.23, 0.90); P = 0.024; 3; 66%
|
0.43 (0.32, 0.59); P < 0.001; 3; 66%
| 1.32 (0.04, 39.86); P = 0.872; 2; 83% | NA |