Liver resection versus radiofrequency ablation for recurrent hepatocellular carcinoma: a systematic review and meta-analysis
作者
Yang, Y; Yu, HL; Tan, X; You, YJ; Liu, FY; Zhao, T; Qi, JN; Li, J; Feng, YM; Zhu, Q
作者单位
[Yang, Yao; Yu, Hongli; You, Yajing; Liu, Fangyuan; Zhao, Tong; Feng, Yuemin] Shandong Univ, Shandong Prov Hosp, Cheeloo Coll Med, Dept Gastroenterol, Jinan, Peoples R China; [Yang, Yao; Yu, Hongli; You, Yajing; Liu, Fangyuan; Zhao, Tong; Qi, Jianni; Li, Jie; Feng, Yuemin] Shandong Prov Engn & Technol Res Ctr Liver Dis Pr, Jinan, Peoples R China; [Tan, Xu] Shandong First Med Univ, Shandong Prov Hosp, Dept Gynecol, Jinan, Peoples R China; [Qi, Jianni] Shandong First Med Univ, Shandong Prov Hosp, Dept Cent Lab, Jinan, Peoples R China; [Li, Jie] Shandong First Med Univ, Shandong Prov Hosp, Dept Infect Dis, Jinan, Peoples R China; [Zhu, Qiang] Shandong First Med Univ, Shandong Prov Hosp, Dept Gastroenterol, Jinan, Peoples R China; [Zhu, Qiang] Xinjiang Med Univ, Affiliated Hosp 1, Dept Gastroenterol, Urumqi, Peoples R China
摘要
Background & aims Liver resection (LR) and radiofrequency ablation (RFA) are commonly used for the treatment of recurrent hepatocellular carcinoma (HCC), but the optimal treatment modality remains unclear. We aimed to compare the efficacy and safety of LR vs RFA for recurrent HCC. Methods We searched PubMed, Embase, Web of Science, and the Cochrane Library for relevant studies. The primary outcomes were overall survival (OS) and disease-free survival (DFS). The secondary outcomes were major complications and hospital stay. Results Eighteen studies with 1991 patients with recurrent HCC were included. The pooled hazard ratio (HR) for OS demonstrated that LR had significantly better OS than RFA in recurrent HCC (HR, 0.81; 95% confidence interval [CI], 0.68-0.95). Specifically, LR was associated with higher 2-, 3- and 4-year OS rates compared with RFA. The pooled HR for DFS showed no significant difference between LR and RFA during the whole follow-up period (HR, 0.90; 95% CI, 0.76-1.07). However, LR was associated with significantly higher 2- to 5-year DFS rates compared to RFA. LR was also associated with more major complications (p < .001) and longer hospital stay (p < .001). Subgroup analyses demonstrated that LR and RFA had similar efficacy in patients with recurrent tumors less than 3 cm or patients presenting three or fewer recurrent nodules. Conclusion LR could provide better long-term survival outcomes than RFA for recurrent HCC patients, while RFA has a higher safety profile. RFA can be a good alternative to LR for patients with small-sized recurrence or patients with a limited number of recurrent nodules. However, as tumor size increases, LR tends to be more efficacious.
关键词
INTRAHEPATIC RECURRENCE; HEPATIC RESECTION; MILAN CRITERIA; RE-RESECTION; SURGICAL RESECTION; HEPATECTOMY; SURVIVAL; RISK; THERAPY; SINGLE