ABSTRACT
Objective: This study determined whether the effect of combination therapy for hepatic carcinoma (HCC) is comparable to surgical resection (SR). According to the guidelines of the American Association for the Study of Liver Disease, radiofrequency ablation (RFA) and SR are recommended for early HCC. However, patients treated with RFA had worse long-term survival than those who received SR. Many studies utilizing the combination therapy with RFA and transarterial chemoembolization (TACE) have reported better prognosis as compared to RFA alone. Materials and Methods: A comprehensive search in databases was conducted. Six retrospective studies and one cohort were enrolled in this meta-analysis. The overall survival (OS), disease-free survival (DFS), and major complications were compared between RFA plus TACE and SR. The pooled hazard ratio and 95% confidence interval (CI) were calculated and analyzed. Results: After comparison, no significant difference in the OS and DFS at 1 and 3 years between the combination therapy and SR was observed (OS1: pooled relative risk [RR]: 0.82, 95% CI [0.56, 1.21]; OS3: pooled RR: 1.07, 95% CI [0.82, 1.39]; DFS1: pooled RR: 0.92, 95% CI [0.58, 1.45]; DFS3: pooled RR: 1.18, 95% CI [1.00, 1.40]). SR had better clinical outcomes than combination therapy with respect to long-term survival and disease progression (OS5: pooled RR: 1.12, 95% CI [1.03, 1.23]; DFS5: pooled RR: 1.15, 95% CI [1.03, 1.28]). Major complications were reduced with combination therapy (pooled RR: 0.46, 95% CI [0.25, 0.85]). Conclusion: SR should remain as the first-line therapy for early HCC
ABSTRACT
Background: Radiofrequency ablation (RFA) is a safe, highly effective, and novel method used to treat benign thyroid nodules. This study aimed to evaluate the efficacy and safety of a combination of RFA and hydrodissection for treating benign thyroid nodules larger than 2 cm. Materials and Methods: The data of 137 patients with at least one thyroid nodule ≥2 cm who underwent RFA combined with hydrodissection at our medical center from November 2014 to October 2016 were analyzed. Ultrasound-guided RFA was applied to 532 nodules, including 139 nodules ≥2 cm and 393 nodes <2 cm. Results: The volumes of thyroid nodules, complications, and changes in thyroid function were analyzed. Ablation treatments were successfully performed without intraoperative skin burns, serious bleeding, or serious thyroid storm. A positive correlation was observed between ablation time and nodule size (R2 = 0.674). Only one patient (0.7%) experienced laryngeal nerve injury after operation. Moreover, the results of thyroid function tests (free triiodothyronine, free thyroxine, and thyroid-stimulating hormone) remained within normal ranges both before and after ablation. The complete ablation rate was 99.06%. The volumes of both nodules ≥2 cm and <2 cm significantly decreased after ablation. Six months after ablation, the average volume of nodules ≥2 cm had decreased to 1.02 ± 2.42 mL, and the volume reduction ratio was 83.11%. Conclusion: The combination of ultrasound-guided RFA with hydrodissection very effectively treats benign thyroid nodules while reducing damage to the surrounding tissues. This method is safe and effective for treating benign thyroid nodules