Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. firstname.lastname@example.org.
BACKGROUND AND AIM:
Radiofrequency Ablation (RFA) and Percutaneous Ethanol Injection (PEI) have been used for patients with hepatocellular carcinoma (HCC) < 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 post-treatment survival quality of RFA versus PEI for treating small HCC < 3 cm.
We conducted a search for published articles in Pubmed, Embase and the Cochrane library until March 2012. Only randomized controlled trials (RCTs) and quasi-randomized clinical trials were included.
Four RCTs with 766 patients were included in this review. We found RFA significantly better than PEI with respect to 3-year overall survival for small HCC (RFA vs. PEI, HR = 0.66, 95% CI: 0.48-0.90, P = 0.009), especially for HCC > 2 cm (HR = 0.56, 95% CI: 0.31-0.99, P = 0.045). RFA had 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. Begg's and Egger's tests detected no significant publication bias among the four RCTs.
RFA appears superior to PEI with respect to local tumor control and 3-year survival for small HCC < 3 cm. RFA was more feasible in patients with HCC > 2 cm or Child-Pugh A liver function.