title: Radiofrequency ablation versus hepatic resection for small hepatocellular carcinomas: a meta-analysis of randomized and nonrandomized controlled trials.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of radiofrequency ablation (RFA) versus hepatic resection (HR) for early hepatocellular carcinoma (HCC) meeting the Milan criteria.
  
  
  METHODS
  A meta-analysis was conducted, and PubMed, Web of Science, the Cochrane Library, CBM, CNKI and VIP databases were systematically searched through November 2012 for randomized and nonrandomized controlled trials (RCTs and NRCTs). The Cochrane Collaboration's tool and modified MINORS score were applied to assess the quality of RCTs and NRCTs, respectively. The GRADE approach was employed to evaluate the strength of evidence.
  
  
  RESULTS
  Three RCTs and twenty-five NRCTs were included. Among 11,873 patients involved, 6,094 patients were treated with RFA, and 5,779 with HR. The pooled results of RCTs demonstrated no significant difference between groups for 1- and 3-year overall survival (OS), recurrence-free survival (RFS) and disease-free survival (DFS) (p>0.05). The 5-year OS (Relative Risk, RR 0.72, 95% CI 0.60 to 0.88) and RFS (RR 0.56, 95% CI 0.40 to 0.78) were lower with RFA than with HR. The 3- and 5-year recurrences with RFA were higher than with HR (RR 1.48, 95% CI 1.14 to 1.94, and RR 1.52, 95% CI 1.18 to 1.97, respectively), but 1-year recurrence and in-hospital mortality showed no significant differences between groups (p>0.05). The complication rate (RR 0.18, 95% CI 0.06 to 0.53) was lower and hospital stays (Mean difference -8.77, 95% CI -10.36 to -7.18) were shorter with RFA than with HR. The pooled results of NRCTs showed that the RFA group had lower 1-, 3- and 5-year OS, RFS and DFS, and higher recurrence than the HR group (p<0.05). But for patients with very early stage HCC, RFA was comparable to HR for OS and recurrence.
  
  
  CONCLUSIONS
  The effectiveness of RFA is comparable to HR, with fewer complications but higher recurrence, especially for very early HCC patients.
authors.affiliation: The Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China ; Department of Medical Administration, 363 Hospital, Chengdu, China.
authors.forename: Yingqiang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: National Chengdu Center for Safety Evaluation of Drugs, West China Hospital, Chengdu, China.
authors.forename: Qianqian
authors.initials: Q
authors.lastname: Luo
authors.affiliation: The Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Youping
authors.initials: Y
authors.lastname: Li
authors.affiliation: West China Medical School, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Shaolin
authors.initials: S
authors.lastname: Deng
authors.affiliation: West China Medical School, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Shiyou
authors.initials: S
authors.lastname: Wei
authors.affiliation: The Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xianglian
authors.initials: X
authors.lastname: Li
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation; D018849:Controlled Clinical Trials as Topic; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016017:Odds Ratio; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D016896:Treatment Outcome; D047368:Tumor Burden