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Journal of Cancer Research and Clinical Oncology

, Volume 139, Issue 12, pp 2021–2033 | Cite as

Percutaneous ablation therapy versus surgical resection in the treatment for early-stage hepatocellular carcinoma: a meta-analysis of 21,494 patients

  • Jia-yan Ni
  • Lin-feng Xu
  • Hong-liang Sun
  • Jing-xing Zhou
  • Yao-ting Chen
  • Jiang-hong Luo
Original Paper

Abstract

Purpose

To compare comprehensively the benefits of radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) with those of surgical resection (SR) in early-stage hepatocellular carcinoma (HCC).

Methods

The potentially relevant studies comparing the efficacy and safety of RFA and/or PEI with those of SR were searched using the databases such as PubMed, MEDLINE, Embase and Chinese databases (CNKI and Wanfang data). Overall survival rate, recurrence-free survival rate and complications were compared and analyzed. Pooled odds ratios with 95 % confidence intervals (95 % CIs) were calculated using either the fixed-effects model or random-effects model. All statistic analyses were conducted using the Review Manager (version 5.1.) from the Cochrane Collaboration.

Results

Our analysis showed that the overall survival rate in patients treated with SR was significantly higher than that of percutaneous ablation therapy (PAT) [SR vs. PAT: 95 % confidence interval (95 % CI)2-year 0.46–0.89, P = 0.009; 95 % CI3-year 0.57–0.83, P < 0.0001; 95 % CI5-year 0.45–0.46, P < 0.0001]. SR was associated with significantly higher recurrence-free survival rate compared with PAT (SR vs. PAT: 95 % CI1-year 0.51–0.90, P = 0.008; 95 % CI2-year 0.41–0.78, P = 0.0004; 95 % CI3-year 0.38–0.77, P = 0.0006; 95 % CI5-year 0.33–0.61, P < 0.0001). SR resulted in longer survival than PAT in HCCs no larger than 3 cm. PAT was associated with less complications compared with SR (PAT vs. SR: 95 % CI 0.14–0.76, P = 0.01).

Conclusions

Although SR was associated with more complications, SR was superior to RFA and PEI for treatment of patients with early-stage HCC.

Keywords

Radiofrequency ablation Percutaneous ethanol injection Surgical resection Hepatocellular carcinoma Meta-analysis 

Notes

Conflict of interest

We declare that we have no conflict of interest.

References

  1. Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430CrossRefPubMedGoogle Scholar
  2. Chen MS, Li JQ, Liang HH et al (2005) Comparison of effects of percutaneous radiofrequency ablation and surgical resection on small hepatocellular carcinoma. Zhonghua Yi Xue Za Zhi 85:80–83PubMedGoogle Scholar
  3. Chen MS, Li JQ, Zheng Y et al (2006) A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 243:321–328PubMedCentralCrossRefPubMedGoogle Scholar
  4. Cho YB, Lee KU, Suh KS et al (2007) Hepatic resection compared to percutaneous ethanol injection for small hepatocellular carcinoma using propensity score matching. J Gastroenterol Hepatol 22:1643–1649CrossRefPubMedGoogle Scholar
  5. Cucchetti A, Cescon M, Trevisani F et al (2012) Current concepts in hepatic resection for hepatocellular carcinoma in cirrhotic patients. World J Gastroenterol 18:6398–6408PubMedCentralCrossRefPubMedGoogle Scholar
  6. Cucchetti A, Piscaglia F, Cescon M et al (2013) Systematic review of surgical resection vs radiofrequency ablation for hepatocellular carcinoma. World J Gastroenterol 19:4106–4118PubMedCentralCrossRefPubMedGoogle Scholar
  7. Desiderio J, Trastulli S, Pasquale R et al (2013) Could radiofrequency ablation replace liver resection for small hepatocellular carcinoma in patients with compensated cirrhosis? A 5-year follow-up. Langenbecks Arch Surg 398:55–62CrossRefPubMedGoogle Scholar
  8. Eisele RM, Chopra SS, Lock JF et al (2013) Treatment of recurrent hepatocellular carcinoma confined to the liver with repeated resection and radiofrequency ablation: a single center experience. Technol Health Care 21:9–18PubMedGoogle Scholar
  9. Feng K, Yan J, Li X et al (2012) A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol 57:794–802CrossRefPubMedGoogle Scholar
  10. Ferenci P, Fried M, Labrecque D et al (2010) World gastroenterology organisation guideline. Hepatocellular carcinoma (HCC): a global perspective. J Gastrointestin Liver Dis 19:311–317PubMedGoogle Scholar
  11. Ghanaati H, Alavian SM, Jafarian A et al (2012) Imaging and Imaging-Guided Interventions in the Diagnosis and Management of Hepatocellular Carcinoma (HCC)-Review of Evidence. Iran J Radiol 9:167–177PubMedCentralCrossRefPubMedGoogle Scholar
  12. Guo WX, Sun JX, Cheng YQ et al (2013) Percutaneous radiofrequency ablation versus partial hepatectomy for small centrally located hepatocellular carcinoma. World J Surg 37:602–607CrossRefPubMedGoogle Scholar
  13. Hasegawa K, Makuuchi M, Takayama T et al (2008) Surgical resection vs. percutaneous ablation for hepatocellular carcinoma: a preliminary report of the Japanese nationwide survey. J Hepatol 49:589–594CrossRefPubMedGoogle Scholar
  14. Hasegawa K, Kokudo N, Makuuchi M et al (2013) Comparison of resection and ablation for hepatocellular carcinoma: a cohort study based on a Japanese nationwide survey. J Hepatol 58:724–729CrossRefPubMedGoogle Scholar
  15. Himoto T, Kurokohchi K, Watanabe S et al (2012) Recent advances in radiofrequency ablation for the management of hepatocellular carcinoma. Hepat Mon 12:e5945PubMedCentralCrossRefPubMedGoogle Scholar
  16. Hong SN, Lee SY, Choi MS et al (2005) Comparing the outcomes of radiofrequency ablation and surgery in patients with a single small hepatocellular carcinoma and well-preserved hepatic function. J Clin Gastroenterol 39:247–252CrossRefPubMedGoogle Scholar
  17. Huang GT, Lee PH, Tsang YM et al (2005) Percutaneous ethanol injection versus surgical resection for the treatment of small hepatocellular carcinoma: a prospective study. Ann Surg 242:36–42PubMedCentralCrossRefPubMedGoogle Scholar
  18. Huang J, Yan L, Cheng Z et al (2010) A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg 252:903–912CrossRefPubMedGoogle Scholar
  19. Islam MN, Azad SA, Karim E et al (2012) Interventional radiology for the treatment of hepatic malignancy. Mymensingh Med J 21:377–390PubMedGoogle Scholar
  20. Kishi Y, Hasegawa K, Kokudo N (2013) Surgical resection for small hepatocellular carcinoma in cirrhosis: the Eastern experience. Recent Results Cancer Res 190:69–84CrossRefPubMedGoogle Scholar
  21. Koda M, Murawaki Y, Hirooka Y et al (2012) Complications of radiofrequency ablation for hepatocellular carcinoma in a multicenter study: an analysis of 16,346 treated nodules in 13,283 patients. Hepatol Res 42:1058–1064CrossRefPubMedGoogle Scholar
  22. Le M, Nelson R, Lee W et al (2012) An appraisal of radiofrequency ablation and surgical resection for hepatocellular carcinoma: results from the surveillance, epidemiology, and end results registry. Am Surg 78:1091–1095PubMedGoogle Scholar
  23. Lencioni R, Crocetti L (2013) Image-guided ablation for hepatocellular carcinoma. Recent Results Cancer Res 190:181–194CrossRefPubMedGoogle Scholar
  24. Livraghi T, Meloni F, Di Stasi M et al (2008) Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology 47:82–89CrossRefPubMedGoogle Scholar
  25. Lü MD, Kuang M, Liang LJ et al (2006) Surgical resection versus percutaneous thermal ablation for early-stage hepatocellular carcinoma: a randomized clinical trial. Zhonghua Yi Xue Za Zhi 86:801–805PubMedGoogle Scholar
  26. Minami Y, Kudo M (2011) Radiofrequency ablation of hepatocellular carcinoma: a literature review. Int J Hepatol 2011:104685PubMedCentralCrossRefPubMedGoogle Scholar
  27. Molinari M, Helton S (2009) Hepatic resection versus radiofrequency ablation for hepatocellular carcinoma in cirrhotic individuals not candidates for liver transplantation: a Markov model decision analysis. Am J Surg 198:396–406CrossRefPubMedGoogle Scholar
  28. Nishikawa H, Inuzuka T, Takeda H et al (2011) Comparison of percutaneous radiofrequency thermal ablation and surgical resection for small hepatocellular carcinoma. BMC Gastroenterol 11:143PubMedCentralCrossRefPubMedGoogle Scholar
  29. Salhab M, Canelo R (2011) An overview of evidence-based management of hepatocellular carcinoma: a meta-analysis. J Cancer Res Ther 7:463–475CrossRefPubMedGoogle Scholar
  30. Takayama T, Makuuchi M, Hasegawa K (2010) Single HCC smaller than 2 cm: surgery or ablation?: surgeon’s perspective. J Hepatobiliary Pancreat Sci 17:422–424CrossRefPubMedGoogle Scholar
  31. Tohme S, Geller DA, Cardinal JS et al (2013) Radiofrequency ablation compared to resection in early-stage hepatocellular carcinoma. HPB (Oxford) 15:210–217CrossRefGoogle Scholar
  32. Tombesi P, Di Vece F, Sartori S (2013) Resection vs thermal ablation of small hepatocellular carcinoma: what’s the first choice? World J Radiol 5:1–4PubMedCentralCrossRefPubMedGoogle Scholar
  33. Toshikuni N, Takuma Y, Goto T et al (2012) Prognostic factors in hepatitis C patients with a single small hepatocellular carcinoma after radiofrequency ablation. Hepatogastroenterology 59:2361–2366PubMedGoogle Scholar
  34. Venook AP, Papandreou C, Furuse J et al (2010) The incidence and epidemiology of hepatocellular carcinoma: a global and regional perspective. Oncologist 15:5–13CrossRefPubMedGoogle Scholar
  35. Wong TC, Lo CM (2013) Resection strategies for hepatocellular carcinoma. Semin Liver Dis 33:273–281CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Jia-yan Ni
    • 1
  • Lin-feng Xu
    • 1
  • Hong-liang Sun
    • 1
  • Jing-xing Zhou
    • 1
  • Yao-ting Chen
    • 1
  • Jiang-hong Luo
    • 1
  1. 1.Department of Interventional Radiology, Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouPeople’s Republic of China

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