Patients met the Milan criteria (single HCC smaller than 5 cm in diameter or up to 3 nodules that were each smaller than 3 cm in diameter) or the UCSF criteria (single tumor smaller than 6.5 cm in diameter or up to 3 nodules that were each smaller than 4.5 cm in diameter and 8 cm in total diameter) with liver function Child-Pugh class A or B (the number of patients with Child-Pugh C was no more than 10%). The PICOS approach was used for eligibility criteria : The purpose of this study was to retrieve the best available evidence and produce a meta-analysis comparing the long-term results of RFA and HR for early hepatocellular carcinoma to reduce research bias and improve the quality of evidence. Therefore, physicians may make an incorrect decision using these recommendations as best evidence without any additional quality evaluations to guide their clinical practice. Our previous study demonstrated that the overall quality of previously published systematic reviews and meta-analyses comparing RFA and HR for small hepatocellular carcinoma was poor, with an inadequate base of evidence. Although RFA may gradually reach acceptability as an alternative treatment, the long-term efficacy and safety should still be evaluated systematically. Radiofrequency ablation (RFA) has higher efficacy and is associated with fewer complications and shorter hospital stays. In addition, few patients can be treated with liver transplantation because of the strict inclusion criteria, high cost, and limited donor liver resources. However, only 20–35% of patients are suitable for liver resection because of the low diagnosis rate for early HCC and to poor liver function. Hepatic resection (HR) and liver transplantation (LT) were recommended by the latest guidelines for early hepatocellular carcinoma meeting the Milan criteria, with the 5-year survival rate potentially reaching 50 to 75%. There were 19.1 million DALYs for liver cancer in 2010, which accounted for 0.8% of the GBD or 10.1% of the DALYS for all neoplasms.

A study based on the human development index (HDI) of Bray F et al estimated an increase in the incidence of new cancer cases of all kinds to 22.2 million annually by 2030, and that increases would be proportionally greatest in low-HDI settings compared with high-HDI countries (76% vs. There were 2.49 billion disability-adjusted life years (DALYs), or 361 DALYs per 1000 population worldwide in 2010, and all neoplasms accounted for 7.6% (189 million DALYs) of global DALYs, an increase of 20 million DALYs (11.8%) compared with 2008. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: The authors have declared that no competing interests exist.Ĭancer is a major component of the global burden of disease (GBD). This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.įunding: This work was funded by National Technology Support Program (2011BAI14B01). Received: Accepted: NovemPublished: January 3, 2014Ĭopyright: © 2014 Wang et al. PLoS ONE 9(1):Įditor: Yujin Hoshida, Icahn School of Medicine at Mount Sinai, United States of America But for patients with very early stage HCC, RFA was comparable to HR for OS and recurrence.Ĭitation: Wang Y, Luo Q, Li Y, Deng S, Wei S, Li X (2014) Radiofrequency Ablation versus Hepatic Resection for Small Hepatocellular Carcinomas: A Meta-Analysis of Randomized and Nonrandomized Controlled Trials. The pooled results of NRCTs showed that the RFA group had lower 1-, 3- and 5-year OS, RFS and DFS, and higher recurrence than the HR group (p<0.05). The complication rate (RR 0.18, 95% CI 0.06 to 0.53) was lower and hospital stays (Mean difference -8.77, 95% CI −10.36 to −7.18) were shorter with RFA than with HR. The 3- and 5-year recurrences with RFA were higher than with HR (RR 1.48, 95% CI 1.14 to 1.94, and RR 1.52, 95% CI 1.18 to 1.97, respectively), but 1-year recurrence and in-hospital mortality showed no significant differences between groups (p>0.05). The 5-year OS (Relative Risk, RR 0.72, 95% CI 0.60 to 0.88) and RFS (RR 0.56, 95% CI 0.40 to 0.78) were lower with RFA than with HR. The pooled results of RCTs demonstrated no significant difference between groups for 1- and 3-year overall survival (OS), recurrence-free survival (RFS) and disease-free survival (DFS) (p>0.05). Among 11,873 patients involved, 6,094 patients were treated with RFA, and 5,779 with HR.

Three RCTs and twenty-five NRCTs were included.

7.18 meta