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Radiofrequency ablation versus percutaneous ethanol injection for hepatocellular carcinoma: a meta-analysis of randomized controlled trials.

Yang B, Zan RY, Wang SY, Li XL, Wei ML, Guo WH, You X, Li J, Liao ZY - World J Surg Oncol (2015)

Bottom Line: In Asian studies, RFA was associated with a lower local recurrence rate than PEI at 1 year (RR, 0.44; 95% CI 0.20 to 0.95; P < 0.05) and 3 years (RR, 0.35; 95% CI 0.22 to 0.55; P < 0.01).RFA was only superior to PEI in Asian studies that included selection bias.Thus, there is insufficient evidence to support the idea that RFA is superior to PEI for patients with cirrhotic HCC.

View Article: PubMed Central - PubMed

Affiliation: Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, No. 17 Renming Road, Chengdu, 610000, People's Republic of China. landayb@163.com.

ABSTRACT

Background: Radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) are treatment methods for patients with early-stage hepatocellular carcinoma (HCC) who are not suitable for surgery. Although some reports indicate that RFA is better than PEI, results from previous reviews and analyses are inconsistent. Therefore, this meta-analysis was performed to more thoroughly evaluate the effects of these treatments in patients with HCC.

Methods: A literature search was conducted using the Excerpta Medica dataBASE, PubMed, the Cochrane Library, the American Society of Clinical Oncology database, the China National Knowledge Infrastructure database, the Wanfang database, the Chinese Biomedical Literature Database, and the Chongqing VIP database without language limitations. The primary outcome evaluated was overall survival, and secondary outcomes included complete response and local recurrence. Comparisons were made between Asian and European studies.

Results: Total pooled and subgroup analyses of Asian studies that included selection biases revealed that RFA is superior to PEI with respect to overall survival (hazard ratio (HR), 0.54; 95% confidence interval (CI), 0.37 to 0.80; P < 0.01) and complete response (relative risk (RR), 1.10; 95% CI 1.03 to 1.18; P < 0.01). However, no significant difference was observed between RFA and PEI in the European studies. In Asian studies, RFA was associated with a lower local recurrence rate than PEI at 1 year (RR, 0.44; 95% CI 0.20 to 0.95; P < 0.05) and 3 years (RR, 0.35; 95% CI 0.22 to 0.55; P < 0.01). However, local recurrence was significantly lower after only 3 years in European studies (RR, 0.50; 95% CI 0.32 to 0.78; P < 0.05).

Conclusions: RFA was only superior to PEI in Asian studies that included selection bias. Thus, there is insufficient evidence to support the idea that RFA is superior to PEI for patients with cirrhotic HCC. Additional large-scale, multicenter, randomized controlled trials that control for selection bias are needed to fully elucidate the optimal treatment method for HCC.

No MeSH data available.


Related in: MedlinePlus

Study flow chart. ASCO, American Society of Clinical Oncology; CNKI, China National Knowledge Infrastructure; CBM, Chinese Biomedical Literature Database; CQVIP, Chongqing VIP database; EMBASE, Excerpta Medica dataBASE.
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Fig1: Study flow chart. ASCO, American Society of Clinical Oncology; CNKI, China National Knowledge Infrastructure; CBM, Chinese Biomedical Literature Database; CQVIP, Chongqing VIP database; EMBASE, Excerpta Medica dataBASE.

Mentions: In total, 2,417 citations were identified in the search of the electronic databases (Figure 1); 687 duplicates were excluded, and 1,730 papers remained. We excluded 1,716 citations based on reading the title and abstract in our initial screening, and 14 full-text articles were read for further assessment. Two papers reported prospective studies without additional details. One prospective nonrandomized study was excluded after obtaining information via email from the author. However, we failed to contact the corresponding author of another prospective nonrandomized study and thus excluded this paper because of its unclear study design. The remaining papers were evaluated, and several more were excluded for the reasons listed in Figure 1. Finally, eight RCTs met all eligibility criteria and were included in this meta-analysis [25-28,30,31,39,40]. Three RCTs were conducted in Italy and were thus grouped as European studies [30,31,40], four originated from Asia (Taiwan, n = 2 [25,26]; Japan, n = 1 [27]; and China, n = 1 [28]), and one study from Egypt was considered as an African study [39]. Although the two studies from Taiwan were performed in the same institution within 2 years, the corresponding author indicated that the randomized patients in these two studies did not overlap.Figure 1


Radiofrequency ablation versus percutaneous ethanol injection for hepatocellular carcinoma: a meta-analysis of randomized controlled trials.

Yang B, Zan RY, Wang SY, Li XL, Wei ML, Guo WH, You X, Li J, Liao ZY - World J Surg Oncol (2015)

Study flow chart. ASCO, American Society of Clinical Oncology; CNKI, China National Knowledge Infrastructure; CBM, Chinese Biomedical Literature Database; CQVIP, Chongqing VIP database; EMBASE, Excerpta Medica dataBASE.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4355988&req=5

Fig1: Study flow chart. ASCO, American Society of Clinical Oncology; CNKI, China National Knowledge Infrastructure; CBM, Chinese Biomedical Literature Database; CQVIP, Chongqing VIP database; EMBASE, Excerpta Medica dataBASE.
Mentions: In total, 2,417 citations were identified in the search of the electronic databases (Figure 1); 687 duplicates were excluded, and 1,730 papers remained. We excluded 1,716 citations based on reading the title and abstract in our initial screening, and 14 full-text articles were read for further assessment. Two papers reported prospective studies without additional details. One prospective nonrandomized study was excluded after obtaining information via email from the author. However, we failed to contact the corresponding author of another prospective nonrandomized study and thus excluded this paper because of its unclear study design. The remaining papers were evaluated, and several more were excluded for the reasons listed in Figure 1. Finally, eight RCTs met all eligibility criteria and were included in this meta-analysis [25-28,30,31,39,40]. Three RCTs were conducted in Italy and were thus grouped as European studies [30,31,40], four originated from Asia (Taiwan, n = 2 [25,26]; Japan, n = 1 [27]; and China, n = 1 [28]), and one study from Egypt was considered as an African study [39]. Although the two studies from Taiwan were performed in the same institution within 2 years, the corresponding author indicated that the randomized patients in these two studies did not overlap.Figure 1

Bottom Line: In Asian studies, RFA was associated with a lower local recurrence rate than PEI at 1 year (RR, 0.44; 95% CI 0.20 to 0.95; P < 0.05) and 3 years (RR, 0.35; 95% CI 0.22 to 0.55; P < 0.01).RFA was only superior to PEI in Asian studies that included selection bias.Thus, there is insufficient evidence to support the idea that RFA is superior to PEI for patients with cirrhotic HCC.

View Article: PubMed Central - PubMed

Affiliation: Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, No. 17 Renming Road, Chengdu, 610000, People's Republic of China. landayb@163.com.

ABSTRACT

Background: Radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) are treatment methods for patients with early-stage hepatocellular carcinoma (HCC) who are not suitable for surgery. Although some reports indicate that RFA is better than PEI, results from previous reviews and analyses are inconsistent. Therefore, this meta-analysis was performed to more thoroughly evaluate the effects of these treatments in patients with HCC.

Methods: A literature search was conducted using the Excerpta Medica dataBASE, PubMed, the Cochrane Library, the American Society of Clinical Oncology database, the China National Knowledge Infrastructure database, the Wanfang database, the Chinese Biomedical Literature Database, and the Chongqing VIP database without language limitations. The primary outcome evaluated was overall survival, and secondary outcomes included complete response and local recurrence. Comparisons were made between Asian and European studies.

Results: Total pooled and subgroup analyses of Asian studies that included selection biases revealed that RFA is superior to PEI with respect to overall survival (hazard ratio (HR), 0.54; 95% confidence interval (CI), 0.37 to 0.80; P < 0.01) and complete response (relative risk (RR), 1.10; 95% CI 1.03 to 1.18; P < 0.01). However, no significant difference was observed between RFA and PEI in the European studies. In Asian studies, RFA was associated with a lower local recurrence rate than PEI at 1 year (RR, 0.44; 95% CI 0.20 to 0.95; P < 0.05) and 3 years (RR, 0.35; 95% CI 0.22 to 0.55; P < 0.01). However, local recurrence was significantly lower after only 3 years in European studies (RR, 0.50; 95% CI 0.32 to 0.78; P < 0.05).

Conclusions: RFA was only superior to PEI in Asian studies that included selection bias. Thus, there is insufficient evidence to support the idea that RFA is superior to PEI for patients with cirrhotic HCC. Additional large-scale, multicenter, randomized controlled trials that control for selection bias are needed to fully elucidate the optimal treatment method for HCC.

No MeSH data available.


Related in: MedlinePlus