Meta-analysis Of Radiofrequency Ablation Versus Repeat Surgical Resection For Recurrent Small Hepatocellular Carcinoma

Objective:To compare the clinical efficacy of radiofrequency ablation and repeated hepatic resection for patients with recurrent small hepatocellular carcinoma(HCC,≤3 nodules and each≤3 cm in diameter),targeting 1-,3-,and 5-years survival rates and 3-year of disease-free survival and complication rate to discuss the effectiveness and safety of the two methods,providing evidence basis for clinical diagnosis and treatment and improving the prognosis of patients.Methods:The computer comprehensively retrieved Pub Med,EMBASE,the Cochrane Library,Chinese Academic Journal(CNKI)and Wang Fang Databases.Without language and national geographic restrictions,we searched data from clinical controlled studies on Radiofrequency ablation and Repeated hepatic resection for recurrent hepatocellular carcinoma were collected from January 1,2000 and July 1,2019.According to the inclusion and exclusion criteria strictly,and finally included 6 clinical case-control studies.The quality of the included literature was evaluated according to the Newcastle-Ottawa Scale(NOS),and the data was further extracted.Rev Man 5.3 statistical software was used for the statistical analysis.Results:A total of 599 patients from 6 case-control studies on radiofrequency ablation and repeated hepatic resection for recurrent HCC were included:(1)There were 4 trials report on 1-year survival rates and without obvious heterogeneity(P=0.93,Ⅰ~2=0%),using the fixed effects model and the results showed that there was no significant difference in1-year survival rates between the two groups:(OR=1.62,95%CI:[0.83,3.17),P=0.21];(2)There were 5 trials report on 3-year survival rates and without obvious heterogeneity(P=0.55,Ⅰ~2=0%),using the fixed effects model and the results showed that there was no significant difference in 3-year survival rates between the two groups:(OR=1.13,95%CI:[0.78,1.64],P=0.51);(3)There were 3 trials report on 3-year tumor-free survival rates,using the random effects model and the results showed that there was no significant difference in 3-year tumor-free survival rates between the two groups:(OR=0.63,95%CI:[0.34,1.16],P=0.14);(4)There were 4 trials report on 5-year survival rates and without obvious heterogeneity(P=0.17,Ⅰ~2=40%),using the fixed effects model and the results showed that there was no significant difference in 5-year survival rates between the two groups:(OR=1.19,95%CI:[0.82,1.73],P=0.35);(5)There were 4 trials report on postoperative complications rates and without obvious heterogeneity(P=0.94,Ⅰ~2=0%),using the fixed effects model and the results showed that the incidence of radiofrequency ablation group was lowerthantherepeatedhepaticresectiongroup:(OR=0.30,95%CI:[0.18,0.51],P<0.00001).Conclusions:For recurrent hepatocellular carcinoma with the diameter no more than 3cm and number of nodules≤3,the results of this meta-analysis shows that:1.There was no significant difference in 1-,3-,5-year survival rates between the two groups;2.There was no significant difference in 3-year tumor-free survival rates between the two groups;3.Radiofrequency ablation was safer than repeated hepatic resection.