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Overall survival and local recurrence following RFA, MWA, and cryoablation of very early and early HCC: a systematic review and Bayesian network meta-analysis

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Abstract

Objective

To compare overall survival (OS) and local recurrence (LR) following radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) for very early and early hepatocellular carcinoma (HCC).

Methods

This systematic review was performed according to the PRISMA guidelines. MEDLINE, Embase, and Cochrane databases were searched. Randomized controlled trials (RCTs) and observational studies were included. OS and LR at 1 year and 3 years were assessed. OS was reported as hazard ratio (HR) with 95% credible intervals (CrI) and LR as relative risk (RR) with 95% CrI, to summarize effect of each comparison.

Results

Nineteen studies (3043 patients), including six RCTs and 13 observational studies, met inclusion criteria. For OS at 1 year, as compared to RFA, CA had HR of 0.81 (95% CrI: 0.43–1.51), and MWA had HR of 1.01 (95% CrI: 0.71–1.43). For OS at 3 years, as compared to RFA, CA had HR of 0.90 (95% CrI: 0.48–1.64) and MWA had HR of 1.07 (95% CrI: 0.73–1.50). For LR at 1 year, CA and MWA had RR of 0.75 (95% CrI: 0.45–1.24) and 0.93 (95% CrI: 0.78–1.14), respectively, as compared to RFA. For LR at 3 years, CA and MWA had RR of 0.96 (0.74–1.23) and 0.98 (0.87–1.09), respectively, as compared to RFA. Overall, none of the comparisons was statistically significant. Age of patients and tumor size did not influence treatment effect.

Conclusions

RFA, MWA, and CA are equally effective for locoregional treatment of very early and early HCC.

Key Points

• There is no significant difference in the OS and LR (at 1 year and 3 years) following ablation of very early and early HCC with RFA, MWA, and CA.

• There was no effect of tumor size on the treatment efficacy.

• More RCTs comparing CA with RFA and MWA should be performed.

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Abbreviations

CA:

Cryoablation

CrI:

Credible interval

HCC:

Hepatocellular carcinoma

HR:

Hazard ratio

LR:

Local recurrence

LTP:

Local tumor progression

MWA:

Microwave ablation

OS:

Overall survival

RCT:

Randomized controlled trial

RFA:

Radiofrequency ablation

RR:

Relative risk

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Authors and Affiliations

  1. Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Pankaj Gupta, Muniraju Maralakunte, Karamvir Chandel, Sreedhara B. Chaluvashetty, Harish Bhujade, Naveen Kalra & Manavjit Singh Sandhu

  2. Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Praveen Kumar-M

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  1. Pankaj Gupta
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  2. Muniraju Maralakunte
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Correspondence to Pankaj Gupta.

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The scientific guarantor of this publication is Dr. Pankaj Gupta (pankajgupta959@gmail.com).

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Gupta, P., Maralakunte, M., Kumar-M, P. et al. Overall survival and local recurrence following RFA, MWA, and cryoablation of very early and early HCC: a systematic review and Bayesian network meta-analysis. Eur Radiol 31, 5400–5408 (2021). https://doi.org/10.1007/s00330-020-07610-1

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