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A systematic review of radiofrequency ablation versus percutaneous ethanol injection for small hepatocellular carcinoma up to 3 cm
Author(s) -
Shen Ai,
Zhang Hua,
Tang Chengyong,
Chen Yong,
Wang Yefei,
Zhang Chao,
Wu Zhongjun
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12162
Subject(s) - medicine , percutaneous ethanol injection , radiofrequency ablation , hepatocellular carcinoma , hazard ratio , randomized controlled trial , percutaneous , confidence interval , hccs , surgery , ablation , radiology
Background and Aim Radiofrequency ablation ( RFA ) and percutaneous ethanol injection ( PEI ) have been used for patients with hepatocellular carcinomas ( HCCs ) < 3 cm, but there is controversy which of the two methods is superior. Therefore, we aimed to conduct a systematic review to assess survival, complete tumor necrosis, recurrence and metastasis, major complications, costs, hospital stays, and posttreatment survival quality of RFA versus PEI for treating small HCCs < 3 cm. Methods We conducted a search for published articles in P ubMed, E mbase, and the C ochrane Library until M arch 2012. Only randomized controlled trials ( RCT s) and quasi‐randomized clinical trials were included. Results Four RCT s with 766 patients were included in this review. We found that RFA is significantly better than PEI with respect to a 3‐year overall survival for small HCCs ( RFA vs PEI , hazard ratios [ HR] = 0.66, 95% confidence interval [ CI] : 0.48–0.90, P = 0.009), especially for HCCs > 2 cm ( HR = 0.56, 95% CI : 0.31–0.99, P = 0.045). RFA had a lower risk of local recurrence ( HR = 0.38, 95% CI : 0.15–0.96, P = 0.040), but no difference is seen for distant intrahepatic recurrence. RFA had higher rates of complete tumor necrosis, but RFA also caused more major complications and was more costly than PEI . B egg's and E gger's tests detected no significant publication bias among the four RCT s. Conclusions RFA appears superior to PEI with respect to local tumor control and 3‐year survival for small HCCs < 3 cm. RFA was more feasible in patients with HCCs > 2 cm or C hild– P ugh A liver function.