Radiofrequency ablation versus surgical resection as first-line treatment for very early stage hepatocellular carcinoma: a systematic review with meta-analysis.

BACKGROUND The optimal first-line treatment for single hepatocellular carcinoma (HCC) ≤ 2 cm, radiofrequency ablation (RFA) or surgical resection (SR), remains unclear. We performed a systematic review and meta-analysis to compare oncological outcomes, morbidity, and mortality rates.

METHODS Indexed published studies comparing RFA and SR were systematically searched in the PubMed, Embase, Scopus, and Cochrane Library databases. The outcomes evaluated included overall survival (OS), recurrence-free survival (RFS), and rates of recurrence, morbidity, and mortality. Hazard ratios (HR) and 95% confidence intervals (CI) were used to assess the outcomes.

RESULTS Fourteen studies (3551 patients), one randomized controlled trial (RCT), and 13 retrospective cohorts were included. No statistically significant difference was observed for the 1-year OS (HR: 1.30, CI: 0.56-3.02, p = 0.54). The OS at 3 and 5 years was significantly greater after SR than after RFA (HR: 2.28, CI: 1.38-3.75, p = 0.001; and HR: 1.66, CI: 1.29-2.15, p = 0.0001, respectively). The RFS at 1, 3, and 5 years was also greater after SR than after RFA (HR: 2.21, CI: 1.31-3.72, p = 0.003; HR: 2.07, CI: 1.50-2.85, p < 0.001; and HR: 1.66, CI: 1.29-2.15, p < 0.001, respectively). The 5-year recurrence rate was higher after RFA than after SR (HR: 1.58, CI: 1.13-2.21, p = 0.008). Insufficient data were available to measure the postoperative outcomes.

CONCLUSION As a first-line treatment for very-early-stage HCC, SR is likely associated with better oncological outcomes than RFA. Further RCTs are required to validate this finding.