Evaluation of clinical outcomes of radiofrequency ablation and surgical resection for hepatocellular carcinoma conforming to the Milan criteria: A systematic review and meta-analysis of recent randomized controlled trials

Abstract

Background and aim: The few systematic reviews that have compared surgical resection (SR) with radiofrequency ablation (RFA) indicated that hepatectomy was superior to RFA in the treatment of hepatocellular carcinoma (HCC) irrespective of overall survival (OS) or disease-free survival (DFS). However, randomized controlled trials (RCTs) are scarce; therefore, there is a lack of robust evidence on the optimal first-line treatment for HCC patients. The purpose of this study was to include all current RCT studies to compare the clinical efficacy between RFA and SR in patients with HCC who meet the Milan criteria using meta-analysis techniques.

Methods: We conducted thorough searches of PubMed, Embase, Cochrane, Web of Knowledge, FDA.gov, and ClinicalTrials.gov for comparative studies (published between 1 January 1996 and 31 December 2019; no language restrictions) of RFA and SR. The main endpoints were OS, DFS, and postoperative complications. Only randomized clinical trials were included. The odds ratios (OR) were pooled and calculated with 95% confidence intervals (CI) for both fixed effects and random effects models.

Results: Eight studies comparing RFA and SR were identified, which included 1177 patients treated with RFA (n = 571) or SR (n = 606). The OR values for patients treated with RFA and SR at 1, 3, and 5 years were OR: 0.91, 95% CI: 0.45-1.38; OR: 0.82, 95% CI: 0.56-1.19; and OR: 1.03, 95% CI: 0.61-1.73, respectively. The OS between the two treatments was not significantly different. The 1-year DFS rates resulting from the two treatments were not statistically different (OR: 0.87, 95% CI: 0.63-1.21). Similarly, according to long-term DFS rates for SR compared with RFA, although the OR value was less than 1, there was no statistical significance (OR: 0.79, 95% CI: 0.58-1.07). However, it is worth noting that RFA has advantages over SR in terms of treatment-related complications (OR: 0.65, 95% CI: 0.44-0.80; P < 0.05), postoperative mortality, length of stay, and hospitalization costs.

Conclusion: For patients with HCC who meet the Milan criteria, RFA exhibited similar clinical efficacy to SR. However, RFA was superior to SR in terms of minor trauma and may be recommended as the first choice for tumors ≤ 4 cm in diameter.

Keywords: Milan criteria; hepatocellular carcinoma; meta-analysis; radiofrequency ablation; resection.