Systematic evaluation of percutaneous radiofrequency ablation versus percutaneous ethanol injection for the treatment of small hepatocellular carcinoma: a meta-analysis

摘要

Background: Radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) have been used for patients with hepatocellular carcinoma (HCC). However, which therapy is superior remains to be further elucidated. We aimed to conduct a systematic review to assess survival and local tumor recurrence rate with RFA compared with PEI therapy for HCC. Methods: We conducted systematic review and meta-analysis of randomized controlled trials (RCTs) published up to 2014 in PubMed, MEDLINE, EMBASE, EBSCO, Springer, Ovid and the Cochrane library. Only RCTs that evaluated survival rate and occurrence of HCC between RFA and PEI therapy were included. The OR (odds ratio) with a 95% confidence interval (Cl) was calculated by the Revman 5.0 software. Results: A total of six studies including 983 HCC patients were eligible for this analysis. The survival rate showed a significant benefit under RFA therapy over PEI at 1-year (P = 0.02, OR = 1.88, 95% Cl: 1.09 to 3.22), 2-years (P = 0.0003, OR = 2.06, 95% Cl: 1.39 to 3.05) and 3-years (P = 0.0007, OR = 1.68, 95% Cl: 1.25 to 2.27). Likewise, RFA achieved significantly lower rates of local tumor recurrence over PEI at 1-year (P = 0.002, OR = 0.43, 95% Cl: 0.26 to 0.73), 2-year (P = 0.03, OR = 0.33, 95% Cl: 0.12 to 0.88) and 3-year (P = 0.003, OR = 0.61, 95% Cl: 0.43 to 0.84). Conclusions: The current evidence suggests that RFA is superior to PEI in better survival and local disease control for small HCCs <5 cm in diameter and that RFA is worthy of promotion in clinical applications.