Therapeutic Effects Of Radiofrequency Ablation, Percutaneous Ethanol Injection And Surgical Resection For Small Hepatocellular Carcinoma: A Meta-analysis

Objective: To evaluate the therapeutic effects of percutaneous radiofrequencyablation (RFA), percutaneous ethanol injection (PEI) and surgical resection (SR) forsmall hepatocellular carcinoma (SHCC).Methods: Clinical data of patients with SHCC underwent RFA, PEI or SR werecollected from the databases of Cochrane Collaboration, EMBASE, PubMed, ChinaNational Knowledge Infrastructure (CNKI), Wanfang and VIP database，or by manualliterature searching. The dataobtained for the Meta analysis using the fixed or randomeffects model. Meta-analyses were conducted using Stata12.0software inhomogeneous research.Results:In accordance with inclusive and exclusive criteria,18RCTs(Randomized Controlled Trials) were included. Total14studies that1959SHCCpatients were associated with RFA versus SR, it included1016patients received RFAand943patients received SR treatment，respectively. Total4studies that12038patients were associated with PEI versus SR，it included3652patients were treatedwith PEI and8386patients received SR. There was no significant difference inoverall1year survival rate compare RFA and SR treatment (P>0.05), but the3yearsand5years survival rates were better in the SR group than RFA group (RR3years=0.87,95%CI:0.78-0.98, Z=2.40, P=0.016<0.05; RR5years=0.71,95%CI：0.51~0.98, Z=3.65,P<0.001）). In the groups of PEI versus SR, there were no statistical significant in the1year and3years overall survival rates between the two groups (P>0.05), while the5years overall survival rates of SR group was better than PEI group（RR5years=0.72,95%CI:0.62-0.85, Z=4.00, P<0.001）. The1year and3years tumor-free survivaltimes were also no significant difference between RFA and SR groups, but the5yearstumor-free survival times of SR group was much better than RFA group(RR5years=0.63,95%CI:0.49-0.80, Z=3.81, P<0.001). In the groups of PEI versus SR,there was no statistical significant in the1year tumor-free survival time between thetwo groups (P>0.05). While the3years and5years tumor-free survival times werebetter in the SR group than PEI group（RR3years=0.66,95%CI:0.44-0.97, Z=2.13, P=0.033; RR5years=0.67,95%CI:0.44~0.98, Z=2.63, P=0.008）.Conclusion: In comparasion of the therapeutic effects of SR, RFA and PEImethods for the treatment of SHCC. The overall long-term therapeutic effects of SRmethod is better than RFA and PEI, while there are no significant differences for theshort-term effects among three groups.