Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou, 510210, Guangdong Province, People's Republic of China,
J Cancer Res Clin Oncol. 2013 Dec;139(12):2021-33. doi: 10.1007/s00432-013-1530-1. Epub 2013 Sep 26.
To compare comprehensively the benefits of radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) with those of surgical resection (SR) in early-stage hepatocellular carcinoma (HCC).
The potentially relevant studies comparing the efficacy and safety of RFA and/or PEI with those of SR were searched using the databases such as PubMed, MEDLINE, Embase and Chinese databases (CNKI and Wanfang data). Overall survival rate, recurrence-free survival rate and complications were compared and analyzed. Pooled odds ratios with 95 % confidence intervals (95 % CIs) were calculated using either the fixed-effects model or random-effects model. All statistic analyses were conducted using the Review Manager (version 5.1.) from the Cochrane Collaboration.
Our analysis showed that the overall survival rate in patients treated with SR was significantly higher than that of percutaneous ablation therapy (PAT) [SR vs. PAT: 95 % confidence interval (95 % CI)2-year 0.46-0.89, P = 0.009; 95 % CI3-year 0.57-0.83, P < 0.0001; 95 % CI5-year 0.45-0.46, P < 0.0001]. SR was associated with significantly higher recurrence-free survival rate compared with PAT (SR vs. PAT: 95 % CI1-year 0.51-0.90, P = 0.008; 95 % CI2-year 0.41-0.78, P = 0.0004; 95 % CI3-year 0.38-0.77, P = 0.0006; 95 % CI5-year 0.33-0.61, P < 0.0001). SR resulted in longer survival than PAT in HCCs no larger than 3 cm. PAT was associated with less complications compared with SR (PAT vs. SR: 95 % CI 0.14-0.76, P = 0.01).
Although SR was associated with more complications, SR was superior to RFA and PEI for treatment of patients with early-stage HCC.
全面比较射频消融（RFA）和经皮乙醇注射（PEI）与手术切除（SR）治疗早期肝细胞癌（HCC）的疗效和安全性。
使用 PubMed、MEDLINE、Embase 和中国数据库（CNKI 和万方数据）等数据库检索比较 RFA 和/或 PEI 与 SR 疗效和安全性的潜在相关研究。比较并分析总生存率、无复发生存率和并发症。使用 Cochrane 协作网的 Review Manager（版本 5.1）计算汇总优势比（OR）及其 95 %置信区间（95 %CI）。所有统计分析均采用固定效应模型或随机效应模型。
分析显示，SR 治疗患者的总生存率明显高于 PAT [SR 与 PAT：2 年 0.46-0.89，P = 0.009；3 年 0.57-0.83，P < 0.0001；5 年 0.45-0.46，P < 0.0001]。SR 与 PAT 相比，无复发生存率明显更高（SR 与 PAT：1 年 0.51-0.90，P = 0.008；2 年 0.41-0.78，P = 0.0004；3 年 0.38-0.77，P = 0.0006；5 年 0.33-0.61，P < 0.0001）。对于直径不超过 3 cm 的 HCC，SR 比 PAT 有更长的生存时间。与 SR 相比，PAT 导致的并发症更少（PAT 与 SR：95 %CI 0.14-0.76，P = 0.01）。
虽然 SR 相关并发症较多，但 SR 治疗早期 HCC 优于 RFA 和 PEI。
