Meta-analysis of surgical resection and radiofrequency ablation for early hepatocellular carcinoma

Abstract

BackgroundThere is no definite agreement on the better therapy (radiofrequency ablation (RFA) versus surgical resection (SR)) for early hepatocellular carcinoma (HCC) eligible for surgical treatments. The purpose of this study is to evaluate the evidence using meta-analytical techniques.MethodsA literature search was undertaken until December 2011 to identify comparative studies evaluating survival rates, recurrence rates, and complications. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated with either the fixed or random effect model.ResultsThirteen articles, comprising two randomized controlled trials(RCTs), were included in the review, with a total of 2,535 patients (1,233 treated with SR and 1,302 with RFA). The overall survival rates were significantly higher in patients treated with SR than RFA after1, 3, and 5 years (respectively: OR, 0.60 (95% CI, 0.42 to 0.86); OR, 0.49 (95% CI, 0.36 to 0.65); OR, 0.60 (95% CI, 0.43 to 0.84)). In the SR group, the 1, 3, and 5 years recurrence rates were significantly lower than the RFA group (respectively: OR, 1.48 (95% CI, 1.05 to 2.08); OR, 1.76 (95% CI, 1.49 to 2.08); OR, 1.68 (95% CI, 1.21 to 2.34)). However, local recurrence between two groups did not exhibit significant difference. For HCC ≤ 3 cm in diameter, SR was better than RFA at the 1, 3, and 5 years overall survival rates (respectively: OR, 0.34 (95% CI, 0.13 to 0.89); OR, 0.56 (95% CI, 0.37 to 0.84); OR, 0.44 (95% CI, 0.31 to 0.62)). This meta-analysis indicated that the complication of SR was higher than RFA (OR, 6.25 (95%CI, 3.12 to 12.52); P = 0.000).ConclusionAlthough local recurrence between two groups did not exhibit significant difference, SR demonstrated significantly improved survival benefits and lower complications for patients with early HCC, especially for HCC ≤ 3 cm in diameter. These findings should be interpreted carefully, owing to the lower level of evidence.

Hepatocellular carcinoma: Surgeon's view on latest findings and future perspectives

“…These findings are confirmed by a meta-analysis by Xu et al [140] also showing a significantly improved survival benefit for patients with early stages of HCC undergoing surgery instead of RFA. When trying to further expand indication for hepatic surgery towards HCC stage B (intermediate stage), one has to compare the outcome results from surgery and TACE.…”

“…When comparing liver resection vs RFA (for patients with stage A HCC who are not suitable for transplantation), there are several meta-analyses showing that hepatic resection is superior to RFA (or PEI) for HCC with regard to recurrence-free and overall survival [38,140,151,152] . Whereas this superiority of surgery is accepted especially for tumors with diameters > 3 cm, there are some contradictory results for small HCC with a diameter < 3 cm.…”

Upregulation of Akt/NF-&kappa;B-regulated inflammation and Akt/Bad-related apoptosis signaling pathway involved in hepatic carcinoma process: suppression by carnosic acid nanoparticle

“…Moreover, the formation and development of liver cancer is associated with high morbidity and mortality. 3,4 A previous study reported the application of some natural production to treat liver cancer in cultured cells, animal models and clinical investigations. This provided useful data for cancer research.…”

“…3 Normal cells divide as many times as needed and stop. 4 They attach to other cells and stay in place in tissues. Cells become cancerous when they lose their ability to stop dividing, attach to other cells, stay where they belong, and die at the proper time.…”

The preventative effect of Akt knockout on liver cancer through modulating NF-κB-regulated inflammation and Bad-related apoptosis signaling pathway

“…However, many liver cancer patients fail to respond to initial chemotherapy, or they acquire drug resistance during the treatment (3). Normal cells divide as many times as needed and stop (4). They attach to other cells and stay in place in tissues.…”