| Background and aims:Primary liver cancer has been listed as one of the most commonly malignances worldwide. The continued increases in incidence and mortality have been observed over several years. Hepatocellular carcinoma (HCC) is the most type which account for 80% of primary liver cancer. Radiofrequency ablation (RFA) has become one of the main curative treatments for liver cancer since it was introduced in 1990. Currently, there were controversial issues in evidence-based clinical studies of the treatment of HCC with RFA. In Chinese populations, the proportion of chronic infection with hepatitis B virus (HBV) in the etiology of HCC is as high as 75%-80%. For those populations, there has been no consensus on whether antiviral therapy after curative treatment such as RFA or resection should be applied. The aims of the present study were to review, summary and evaluate the high-quality clinical evidences on the therapies of HCC with RFA. Based on searching the databases for the therapies of HCC, the issues on treatment with RFA and/or RFA combined with other related therapies for HCC, which are controversial or require further evaluation, were analyzed and then draw a conclusion by using meta-analytic methods.Methods:Randomized controlled trials (RCTs) and meta-analysis or systematic reviews (SR) referred to therapies of HCC with RFA were identified by searching several databases. The searches were updated in July 2014. We reviewed and evaluated the high-quality clinical studies on the therapies of HCC with RFA, and based on the current evidences, we further evaluate two subjects which are controversial by conducting systematic reviews or meta-analyses.Results:After searching for the clinical studies referred the therapies of HCC and reviewing them, we therefore drew up three subjects:"The Evaluation of Level of Evidence on Therapies of Hepatocellular Carcinoma with Radiofrequency Ablation" (the first study), "Combination of Radiofrequency Ablation with Percutaneous Ethanol Injection for Hepatocellular Carcinoma:A Systematic Review" (the second study), and "Efficacy of Antiviral Therapy with Nucleotide/Nucleoside Analogs after Curative Treatment for Patients with Hepatitis B Virus-Related Hepatocellular Carcinoma:A Systematic Review" (the third study). Fifty-five high-quality studies were included in the first study and the results of evaluation showed that RFA has significant benefit for patients with HCC less than 5.0 cm in diameter when compared with percutaneous ethanol injection (PEI), but less benefit for those patients than hepatic resection, microwave ablation (MWA), laser ablation (LA) or cryosurgery ablation (CSA). Combination of RFA with other therapies (trans-arterial chemoembolization (TACE) or systemic chemotherapy) could improve overall survival and reduce recurrence of patients with HCC larger than 3.0 cm in diameter. Five studies were included in the second study and the results of pooled analysis indicated that RFA combined with PEI could significantly improve the survival of patient with HCC compared with RFA alone, and the local recurrence was also reduced by the combination therapy. Twelve studies were included in the third study and the results of pooled analysis showed that antiviral therapy with nucleotide/nucleoside analogs (NA) could improve survival and reduce early recurrence for patients with HBV-related HCC after curative treatment.Conclusions:Based on current evidences, for HCC less than 3.0 cm in diameter, RFA alone could achieve in a better efficacy, and the combination treatment modality is not necessary; however, for HCC larger than 3.0 cm in diameter, the treatment of RFA combined with other therapy could get a better effect than RFA alone; antiviral therapy with NA could significantly benefit the patients with HBV-related HCC after curative treatment such as RFA, PEI or hepatic resection. |
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