Han Jie, Fan Yu-Chen, Wang Kai
Department of Hepatology, Qilu Hospital of Shandong University and Hepatology Institute of Shandong University, Jinan, China.
Medicine (Baltimore). 2020 Oct 23;99(43):e22703. doi: 10.1097/MD.0000000000022703.
Several randomized control trials (RCTs) were conducted to compare microwave ablation (MWA) and radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) over the years. The purpose of this study was to compare the efficacy of RFA and MWA for early stage HCC.
Studies were systematically searched on Emabse, Ovid Medline, PubMed, and Cochrane Library until March 20, 2020. Continuous variables and dichotomous variables were compared using weighted mean difference (WMD) and odds ratio (OR), respectively. For the comparison of overall survival (OS) and disease-free survival (DFS), the hazard ratio (HR) and 95% confidence interval (CI) were extracted from univariate analysis or survival plots.
A total of 26 studies (5 RCTs and 21 cohorts) with 4396 patients (2393 patients in RFA and 2003 patients in MWA) were included in our study. Of these patients, 47% received treatment under general anesthesia in the MWA group and 84% in the RFA group (OR = 0.529, P < .001). The median ablation time was reduced in the MWA group (12 minutes) compared with RFA group (29 minutes) (WMD = -15.674, P < .001). In total, 17.6% patients exhibited progression during follow-up in the MWA group compared with 19.5% in the RFA group (OR = 0.877, P = .225). No statistically significant differences were observed between MWA and RFA groups in terms of OS and DFS (HR = 0.891 and 1.014, P = .222 and .852, respectively).
MWA exhibited similar therapeutic effects as RFA in the treatment of early stage HCC. Given the shorter ablation time, MWA can be performed under local anesthesia.
多年来开展了多项随机对照试验（RCT）比较微波消融（MWA）与射频消融（RFA）治疗肝细胞癌（HCC）的效果。本研究旨在比较RFA和MWA治疗早期HCC的疗效。
在Emabse、Ovid Medline、PubMed和Cochrane图书馆系统检索研究，截至2020年3月20日。连续变量和二分变量分别采用加权均数差（WMD）和比值比（OR）进行比较。对于总生存期（OS）和无病生存期（DFS）的比较，从单因素分析或生存曲线中提取风险比（HR）和95%置信区间（CI）。
本研究共纳入26项研究（5项RCT和21项队列研究），4396例患者（RFA组2393例，MWA组2003例）。这些患者中，MWA组47%在全身麻醉下接受治疗，RFA组为84%（OR = 0.529，P < 0.001）。与RFA组（29分钟）相比，MWA组的中位消融时间缩短（12分钟）（WMD = -15.674，P < 0.001）。MWA组共有17.6%的患者在随访期间出现疾病进展，而RFA组为19.5%（OR = 0.877，P = 0.225）。MWA组和RFA组在OS和DFS方面未观察到统计学显著差异（HR分别为0.891和1.014，P分别为0.222和0.852）。
MWA在治疗早期HCC方面显示出与RFA相似的治疗效果。鉴于消融时间较短，MWA可在局部麻醉下进行。
