| Hepacellular carcinoma(HCC)is the sixth most common malignant tumor and the leading cause of mortality in patient with liver cirrhosis.The patients with tumors conforming to the Milan criteria(single HCC≤5 cm or up 3 nodules <3 cm)will benefit from hepatic resection(HR),liver transplantation(LT),or radiofrequency ablation(RFA).Theoretically,the best treatment is liver transplantation.However,the scarcity of donors and high costs are major limitations of this treatment strategy.Thus,HR is still considered trustworthy.Nevertheless,the associated cirrhosis limits the extent of surgery and increases the risk of postoperative liver failure.At this situation,many nonsurgical ablative methods have been developed.For percutaneous ablation,RFA needs shorter ablation time,low complication rate and repeated treatment in case of tumor recurrence.Compared with RFA,MWA was be invented later,MWA has been predominantly used in China and Japan,but the technique is now gaining popularity in the West.MWA technology has theoretical advantages over the RFA methods.The MWA related to technical factors including reduced “heat-sink” effect,rapid increase and maintenance of higher intra-tumoural temperatures,deeper penetration,faster ablation times and the ability to achieve larger tumour ablation volumes.There has some research about RFA and MWA,but has inconsistent conclusion.There were also have some research about HR and percutaneous ablation,and the conclusion was unknown.There for,we use the meat-analysis and TSA to evaluate the effectiveness and safety about the different methods,and hope give guidance for clinical practice.Objective: To systematically evaluate the efficacy and safety of RFA versus MWA and RFA versus HR during HCC by using meta-analysis and trial sequential analysis(TSA).Methods: We electronically searched Pub Med,The Cochrane Library,EMbase,CNKI,VIP,CBM and WangFang Data to collect randomized controlled trials(RCTs)and cohort study about topical.The duration of search was form the inception of the databases to June 2017.After literature selection,data extraction and quality assessment conducted by two reviewers independently,we carried out meta-analysis and TSA analysis by using RevMan 5.3 version,R 3.4.1 version and TSA v0.9Beta respectively.1.Effectiveness and Safety of MWA versus RFA during HCCResults: A total of 6 RCTs and 11 cohort studies involving 1782 patients were included.The results of meta-analysis revealed that there was no difference at complete ablation rate(OR=0.88,95%CI 0.63 to1.22,P=0.44).There was no difference at overall local recurrence rate(OR=1.2,95%CI 0.90 to 1.59,P=0.21).There was no difference at 1-and 3 year overall survival rate between RFA and MWA(OR=0.72,95%CI 0.45 to 1.14,P=0.16)、(OR=1.13,95%CI 0.85 to 1.50,P=0.41).There was also no difference at complete ablation rate and local recurrence rate in the diameter of tumor ≤3cm or between 3 to 5 cm.At the ablation time the MWA less than RFA(MD=8.08 95%CI 4.79 to 11.37,P<0.00001).At the majorcomplication,the incidence rate of postoperative hepatalgia and fever was higher in MWA group.The TSA results showed that the current evidence need more studies included to been proved.Conclusions: Our results indicate a similar efficacy between the two percutaneous techniques in HCC and the MWA was a higher incidence rate in postoperative hepatalgia and fever,but MMA need less ablation time.Therefore,the conclusion needs more high-quality studies to prove.2 Effectiveness and Safety of RFA versus MWA during HCCResults: A total of 5 RCTs and 35 cohort studies involving 17743 patients were included.The results of meta-analysis revealed that,compared to the RFA group,the overall survival rate and disease-free survival rate in the HR group was significantly higher(hazard ratio=0.84,95%CI 0.78 to 0.91,P<0.0001;hazard ratio=0.80,95%CI 0.69 to 0.92,P<0.002,respectively).In the 3-year overall and disease-free survival rate,trial sequential analysis showed that the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit establishing sufficient and conclusive evidence.In the 3-year and 5-year overall and disease-free survival rate,the conclusion was accordance.In the subgroup analysis,the overall and disease-free survival rate showed no significant differences between two groups for patients with HCCs smaller 3 cm.But the major complications rate in HR group were significantly higher compared to the RFA group(OR=3.39,95%CI: 2.77 to 4.15,p<0.00001.The HR group also had significant longer hospital-stay than RFA group(MD=6.09,95%: 4.51 to 7.68,p<0.00001).Conclusion: HR has a higher overall and disease-free survival rate in treating HCC and it is proposed as the first-line in clinical practice,although HR associated with higher major complication rate and longer hospital-stay.For patients with small HCCs smaller 3 cm,RFA may be an alternative to HR. |
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