Objective: To compare the effectiveness and safety of radiofrequency ablation (RFA) with other therapeutic methods for patients with early hepatocellular carcinoma (HCC).
Methods: Randomized clinical trials (RCTs) which compared the efficacy or safety of RFA with other therapeutic methods for primary hepatocellular carcinoma in Cochrane library, EMBASE, PubMed, OVID and CBM were searched. Trials were considered of high quality if methodological quality score was 3 or more according to Jadad standard. Statistical heterogeneity between trials was evaluated by STATA 9.0 and considered to exist when P < 0.1. Heterogeneity of the included articles was tested and used to select proper effective model for calculation. Sensitivity analysis was performed and publication bias was investigated through visual inspection of funnel plots and Egger regression model.
Results: Six RCTs including 862 cases were analyzed. As compared with other therapeutic approaches, RFA significantly increased 3-year overall survival rate and reduced local recurrence rate of early hepatocellular carcinoma; the total OR were 2.06 (95% CI being 1.54-2.77, P = 0.000) and 0.40 (95% CI being 0.28-0.57, P = 0.000) respectively. As compared with other therapeutic approaches, the total OR of new HCC recurrence rates, extrahepatic metastasis rate and major complications in patients with HCC treated with RFA were 0.92 (95% CI being 0.68-1.24), 0.98 (95% CI being 0.30-3.22), 1.35 (95% CI being 0.49-3.77) respectively, showing no significant differences (P > 0.05). Inspection of the funnel plots for all outcome measures did not reveal evidence of publication bias (P = 0.670, 0.160, 0.884, 0.087, 0.317, respectively, by Egger regression model).
Conclusions: RFA is superior to other treatment methods with respect to local recurrence and 3 year overall survival in early HCC and is the preferred therapeutic method for small HCC because it is minimally invasive, simple and convenient.