Meta-analysis of surgical resection and radiofrequency ablation for early hepatocellular carcinoma
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.
- Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010, 127:2893–2917. CrossRef
- Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D: Global cancer statistics. CA Cancer J Clin 2011, 61:69–90. CrossRef
- Yang JD, Roberts LR: Hepatocellular carcinoma: aglobal view. Nat Rev GastroenterolHepatol 2010, 7:448–458. CrossRef
- Benson AB 3rd, 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.
- Llovet JM, Burroughs A, Bruix J: Hepatocellular carcinoma. Lancet 2003, 362:1907–1917. CrossRef
- Llovet JM, Bruix J: Novel advancements in the management of hepatocellular carcinoma in 2008. J Hepatol 2008,48(Suppl 1):S20-S37. CrossRef
- Zhang YY, Xia HH: Novel therapeutic approaches for hepatocellular carcinoma: fact and fiction. World J of Gastroenterol 2008, 14:1641–1642. CrossRef
- Merchant N, David CS, Cunningham SC: Early hepatocellular carcinoma: transplantation versus resection: the case for liver resection. Int J Hepatol 2011, 2011:142085.
- 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. CrossRef
- Hasegawa K, Kokudo N, Makuuchi M: Surgical management of hepatocellular carcinoma. Liver resection and liver transplantation. Saudi Med J 2007, 28:1171–1179.
- 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. CrossRef
- Bruix J, Sherman M: Management of hepatocellular carcinoma: an update. Hepatology 2011, 53:1020–1022. 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.
- Tiong L, Maddern GJ: Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. Br J Surg 2011, 98:1210–1224. 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.
- Molinari M, Helton S: Hepatic resection versus radiofrequency ablation for hepatocellular carcinoma in cirrhotic individuals not candidates for liver transplantation: a Markov model decision analysis. Am J Surg 2009, 198:396–406. CrossRef
- 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. CrossRef
- Livraghi T, Meloni F, Di Stasi M, Rolle E, Solbiati L, Tinelli C, Rossi S: Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice? Hepatology 2008, 47:82–89. CrossRef
- 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.
- 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. CrossRef
- 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. CrossRef
- 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. 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. CrossRef
- 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.
- Kudo M: Radiofrequency ablation for hepatocellular carcinoma: updated review in 2010. Oncology 2010,78(Suppl 1):113–124. CrossRef
- 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.
- Liu L, Miao R, Yang H, Lu X, Zhao Y, Mao Y, Zhong S, Huang J, Sang X, Zhao H: Prognostic factors after liver resection for hepatocellular carcinoma: a single-center experience from China. Am J Surg 2012, 203:741–750. CrossRef
- Ko CJ, Chien SY, Chou CT, Chen LS, Chen ML, Chen YL: Factors affecting prognosis of small hepatocellular carcinoma in Taiwanese patients following hepatic resection. Can J Gastroenterol 2011, 25:485–491.
- 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.
- Bangard C: Radiofrequency of the liver - an update. RoFo 2011, 183:704–713. CrossRef
- 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. CrossRef
- Meta-analysis of surgical resection and radiofrequency ablation for early hepatocellular carcinoma
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
World Journal of Surgical Oncology
- Online Date
- August 2012
- Online ISSN
- BioMed Central
- Additional Links
- Hepatocellular carcinoma
- radiofrequency ablation
- Author Affiliations
- 1. Department of General Surgery, Huai’an First People’s Hospital, Nanjing Medical University, 6 Beijing Road West, 223300, Huai’an, Jiangsu Province, People’s Republic of China
- 2. Department of General Surgery, First Affiliated Hospital, Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, People’s Republic of China