Comparison Between RFA With PEI In The Treatment Of Small HCC In Cirrhosis: A Meta-analysis

Objective:To evaluate the effect of Radiofrequency ablation(RFA) in the treatment of small hepatocellular carcinoma(HCC)(≤5cm in diameter and/or 1-3HCCs ) in Cirrhosis patients when comparing with percutaneous ethanol injection(PEI).Methods:We searched PubMed(1966-2008),Cochrane Library2008, EMBASE databases(1989-2008) and Chinese Biomedicine databases(1980-2008).We selected the randomized clinical trials evaluating RFA vs.PEI and their data.Outcomes were overall survival or death Hazard ratio,local recurrence and complete tumour necrosis.Meta-analysis software was used odds ratio(OR)and Hazard ratio(HR) or Relative risk(RR) and their 95%confidence intervals and Q-test for heterogeneity were calculated.Results:Five Prospective RCTs were identified including 754 patients(354 in RFA group,400 in PEI group).The complete tumour necrosis was significantly higher in patients treated with RFA than in those treated with PEI (OR=5.21 95%CI 2.670～10.169,P＜0.001,heterogeneity P=0.281).The death Hazard ratio was significantly lower in patients treated with RFA than in those treated with PEI(HR0.635 95%CI 0.483～0.835,P=0.001;heterogeneity p=0.591).The 1 and 3 years local recurrence rate is significantly lower in patients treated with RFA than in those treated with PEI(RR0.620 95%CI 0.447～0.859,P=0.004;heterogeneity P=0.510.RR0.823 95%CI 0.737～0.919, P=0.001;heterogeneity P=0.875).A small number of adverse events were reported in the two treatments.Conclusion:RFA is superior to PEI in the treatment of small HCC in Cirrhosis with respect to overall survival and tumor response.RFA shows a significantly smaller risk of death Hazard and local recurrence.