Radiofrequency Ablation Combined with Transcatheter Arterial Chemoembolization Therapy Versus Surgical Resection for Hepatocellular Carcinoma within the Milan Criteria: A Meta-Analysis

Abstract

ObjectiveTo meta-analytically compare combined transarterial chemoembolization (TACE) plus radiofrequency ablation (RFA) and surgical resection (SR) for the treatment of hepatocellular carcinoma (HCC) within the Milan criteria.Materials and MethodsPubMed, Medline, Embase, and Cochrane Library were searched for studies comparing these two therapies that were published between January 2006 and August 2017. Overall survival rate (OS), recurrence-free survival rate (RFS), major complications and the average length of hospital stay were compared between these two therapies. Meta-analytic pooled odds ratio (OR) was calculated using TACE plus RFA as the base category.ResultsSeven case-control studies and one randomized trial were identified. Meta-analytic results revealed that, compared with SR, TACE plus RFA had significantly higher 1-year OS (OR for survival = 0.50, p = 0.009) and lower major complications (OR = 1.88, p = 0.02) after therapy. Three studies reported on the length of hospital stay. The average length ± standard deviation reported in individual studies for SR and TACE plus RFA groups was 19.8 ± 8.4 days and 7.4 ± 2.2 days, respectively; 18.7 ± 4.9 days and 11.5 ± 6.9 days, respectively; and 16.6 ± 6.7 days and 8.5 ± 4.1 days, respectively (p < 0.0001 for all studies). Three or 5-year OS and 1-, 3-, or 5-year RFS did not significantly differ between the two therapies.ConclusionCombined TACE plus RFA may be an alternative to SR for the treatment of patients with HCC within Milan the criteria. Non-randomized design in most of the original studies was a limitation.

Chemoembolization Combined with Radiofrequency Ablation for Medium-Sized Hepatocellular Carcinoma: A Propensity-Score Analysis

“…There was no significant difference in complication rates, but the hospital stay was significantly shorter in the chemoembolization/RF ablation group than in the surgical resection group (8.4 vs 16.9 d; P < .001) (36). Wang et al (38) performed a meta-analysis of comparative studies of combined chemoembolization/RF ablation versus surgical resection for HCC meeting the Milan criteria for transplantation, and they concluded that combined chemoembolization/RF ablation may be a viable alternative to surgical resection for the treatment of patients with HCC meeting the Milan criteria. However, they also identified the nonrandomized designs of most of the included original studies as a limitation.…”

“…However, these previous studies (20-22) had only 2 arms each, without the potential third arm of chemoembolization alone, making it difficult to evaluate the relative added contribution of chemoembolization or RF ablation in the combined chemoembolization/RF ablation arm (35). Previous studies also have reported that the results of combined chemoembolization/RF ablation are comparable to those of surgical resection for medium-sized HCCs (36)(37)(38). A recent study by Lee et al (36) compared longterm outcomes of combined chemoembolization/RF ablation (n ¼ 60) versus surgical resection (n ¼ 139) in the treatment of single medium-sized (3-5-cm) HCCs.…”

<p>Efficacy and Safety of Supplemental Transarterial Chemoembolization Through Extrahepatic Collateral Arteries with Drug-eluting Beads: Treatment for Unresectable Hepatocellular Carcinoma</p>

“…Major complication was defined as an event that leads to substantial morbidity and disability, an increased level of care, or substantially lengthens hospital stay. 22…”

Hepatocellular Carcinoma: Combined Transarterial Chemoembolization and Ablation

“…29 Meta-analyses have also concluded that combination of TACE and RFA is associated with a higher OS rate than RFA or TACE alone. [29][30][31][32] The author of one meta-analysis suggested that combined TACE and RFA may be an alternative to surgical resection in the treatment of patients with HCC. 32 The majority of studies reviewed were nonrandomized in these meta-analyses.…”

“…[29][30][31][32] The author of one meta-analysis suggested that combined TACE and RFA may be an alternative to surgical resection in the treatment of patients with HCC. 32 The majority of studies reviewed were nonrandomized in these meta-analyses. These studies did not, however, consider the potential toxicity of combination therapy.…”