A comparison between radiofrequency ablation combined with transarterial chemoembolization and surgical resection in hepatic carcinoma: A meta-analysis

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