P-0103 - Comparison of Hepatic Resection and Radiofrequency Ablation for Small Hepatocellular Carcinoma: A Meta-Analysis of 16,103 Patients
|Date||28 June 2014|
|Event||World GI 2014|
|Topics|| Hepatobiliary Cancers
Surgery and/or Radiotherapy of Cancer
|Citation||Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165|
Q. Xu1, S. Kobayashi2, X. Meng1
Hepatocellular carcinoma (HCC) is the seventh most common malignant tumor and the third leading cause of cancer-related deaths worldwide. Hepatic resection (HR) and radiofrequency ablation (RFA) represent the most common treatments for patients with HCC. This study aims to evaluate the evidence from previous studies that directly compare the therapeutic effects of HR and RFA in the treatment of small HCC by summarizing it quantitatively with a meta-analysis approach.
A literature search was undertaken until August 2013 to identify comparative studies reporting overall survival rates, disease-free survival rates, complications, and hospital stays. The quality of all selected articles was assessed by using the nine-star Newcastle-Ottawa Scale. Pooled odds ratios (OR), weighted mean difference (WMD) and 95% confidence intervals (95% CI) were calculated with the random effect model.
In total, three randomized controlled trials and 28 nonrandomized controlled trials were included in the analysis, with a total of 16,103 patients: 8,252 treated with RFA and 7,851 with HR. The overall and disease-free survival in the HR group were significantly better than those in the RFA group for HCCs ≤5 cm; the 5-year overall and disease-free survival rates were 71.3% versus 60.8% and 37.7% versus 26.6%, respectively. In the subgroup analysis, the disease-free and overall survival in the HR group were also significantly better than those in the RFA group for HCCs ≤3 cm, whereas there were no significant differences between the two groups for HCCs ≤2 cm. The detailed comparisons are provided in Table 1.
Although HR is associated with more major complications and longer hospital stay, HR is proposed as the first-line treatment rather than RFA for patients with HCCs larger than 2 cm. In the patients with HCCs of 2 cm or less, RFA maybe an alternative to HR because of their comparable long-term efficacy. However, these findings should be interpreted carefully, owing to the lower level of evidence.