title: Radiofrequency ablation versus percutaneous ethanol injection for hepatocellular carcinoma: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) are treatment methods for patients with early-stage hepatocellular carcinoma (HCC) who are not suitable for surgery. Although some reports indicate that RFA is better than PEI, results from previous reviews and analyses are inconsistent. Therefore, this meta-analysis was performed to more thoroughly evaluate the effects of these treatments in patients with HCC.
  
  
  METHODS
  A literature search was conducted using the Excerpta Medica dataBASE, PubMed, the Cochrane Library, the American Society of Clinical Oncology database, the China National Knowledge Infrastructure database, the Wanfang database, the Chinese Biomedical Literature Database, and the Chongqing VIP database without language limitations. The primary outcome evaluated was overall survival, and secondary outcomes included complete response and local recurrence. Comparisons were made between Asian and European studies.
  
  
  RESULTS
  Total pooled and subgroup analyses of Asian studies that included selection biases revealed that RFA is superior to PEI with respect to overall survival (hazard ratio (HR), 0.54; 95% confidence interval (CI), 0.37 to 0.80; P < 0.01) and complete response (relative risk (RR), 1.10; 95% CI 1.03 to 1.18; P < 0.01). However, no significant difference was observed between RFA and PEI in the European studies. In Asian studies, RFA was associated with a lower local recurrence rate than PEI at 1 year (RR, 0.44; 95% CI 0.20 to 0.95; P < 0.05) and 3 years (RR, 0.35; 95% CI 0.22 to 0.55; P < 0.01). However, local recurrence was significantly lower after only 3 years in European studies (RR, 0.50; 95% CI 0.32 to 0.78; P < 0.05).
  
  
  CONCLUSIONS
  RFA was only superior to PEI in Asian studies that included selection bias. Thus, there is insufficient evidence to support the idea that RFA is superior to PEI for patients with cirrhotic HCC. Additional large-scale, multicenter, randomized controlled trials that control for selection bias are needed to fully elucidate the optimal treatment method for HCC.
authors.affiliation: Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, No. 17 Renming Road, Chengdu, 610000, People's Republic of China. landayb@163.com.
authors.forename: Biao
authors.initials: B
authors.lastname: Yang
authors.affiliation: Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, No. 17 Renming Road, Chengdu, 610000, People's Republic of China. Zanruiyu2012@163.com.
authors.forename: Rui-yu
authors.initials: RY
authors.lastname: Zan
authors.affiliation: Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. 1037457494@qq.Com.
authors.forename: Shi-yu
authors.initials: SY
authors.lastname: Wang
authors.affiliation: Chinese Evidence-Based Medicine Centre, West China Hospital, West China Medical School, Sichuan University, No. 17 Renming Road, Chengdu, 610000, China. 422253878@qq.com.
authors.forename: Xiang-lian
authors.initials: XL
authors.lastname: Li
authors.affiliation: Chinese Evidence-Based Medicine Centre, West China Hospital, West China Medical School, Sichuan University, No. 17 Renming Road, Chengdu, 610000, China. maolingwei@hotmail.com.
authors.forename: Mao-ling
authors.initials: ML
authors.lastname: Wei
authors.affiliation: Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, No. 17 Renming Road, Chengdu, 610000, People's Republic of China. Bruce212@126.com.
authors.forename: Wen-hao
authors.initials: WH
authors.lastname: Guo
authors.affiliation: Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, No. 17 Renming Road, Chengdu, 610000, People's Republic of China. Youxin_dm@sina.com.
authors.forename: Xin
authors.initials: X
authors.lastname: You
authors.affiliation: Chinese Evidence-Based Medicine Centre, West China Hospital, West China Medical School, Sichuan University, No. 17 Renming Road, Chengdu, 610000, China. Lijing68@hotmail.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, No. 17 Renming Road, Chengdu, 610000, People's Republic of China. zhengyinliao@vip.sina.com.
authors.forename: Zheng-yin
authors.initials: ZY
authors.lastname: Liao
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D017115:Catheter Ablation; D000431:Ethanol / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008113:Liver Neoplasms / Q000628:therapy*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic
chemical_list: D000891:Anti-Infective Agents, Local; D000431:Ethanol