title: Radiofrequency ablation versus resection for Barcelona clinic liver cancer very early/early stage hepatocellular carcinoma: a systematic review.
abstract: OBJECTIVE
  To compare the long-term survival outcomes of radiofrequency ablation and liver resection for single very early/early stage hepatocellular carcinoma (HCC).
  
  
  METHODS
  The Cochrane Library (Issue 3, 2015), Embase (1974 to March 15, 2015), PubMed (1950 to March 15, 2015), Web of Science (1900 to March 15, 2015), and Chinese Biomedical Literature Database (1978 to March 15, 2015) were searched to identify relevant trials. Only trials that compared radiofrequency ablation and liver resection for single very early stage (≤2 cm) or early stage (≤3 cm) HCC according to the Barcelona clinic liver cancer (BCLC) staging system were considered for inclusion in this review. The primary outcomes that we analyzed were the 3-year and 5-year overall survival (OS) rates, and the secondary outcomes that we analyzed were the 3-year and 5-year disease-free survival (DFS) rates. Review Manager 5.3 was used to perform a cumulative meta-analysis. Possible publication bias was examined using a funnel plot. A random-effects model was applied to summarize the various outcomes.
  
  
  RESULTS
  Six studies involving 947 patients were identified that compared radiofrequency ablation (n=528) to liver resection (n=419) for single BCLC very early HCC. In these six studies, the rates of 3-year OS, 5-year OS, 3-year DFS, and 5-year DFS were significantly lower in the radiofrequency ablation group than in the liver resection group (risk ratio [RR] =0.90, 95% confidence interval [CI]: 0.83-0.98, P=0.01; RR =0.84, 95% CI: 0.75-0.95, P=0.004; RR =0.77, 95% CI: 0.60-0.98, P=0.04; and RR =0.70, 95% CI: 0.52-0.94, P=0.02, respectively). Ten studies involving 2,501 patients were identified that compared radiofrequency ablation (n=1,476) to liver resection (n=1,025) for single BCLC early HCC. In these ten studies, the rates of 3-year OS, 5-year OS, 3-year DFS, and 5-year DFS were also significantly lower in the radiofrequency ablation group than in the liver resection group (RR =0.93, 95% CI: 0.88-0.98, P=0.003; RR =0.84, 95% CI: 0.75-0.94, P=0.002; RR =0.72, 95% CI: 0.58-0.89, P=0.002; and RR =0.47, 95% CI: 0.33-0.67, P<0.0001, respectively).
  
  
  CONCLUSIONS
  The long-term survival outcomes for patients with single BCLC very early/early stage HCC appear to be superior after liver resection compared to radiofrequency ablation.
authors.affiliation: Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China.
authors.forename: Zhen-Xin
authors.initials: ZX
authors.lastname: He
authors.affiliation: State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, People's Republic of China.
authors.forename: Pu
authors.initials: P
authors.lastname: Xiang
authors.affiliation: Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China.
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Gong
authors.affiliation: Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
authors.forename: Nan-Sheng
authors.initials: NS
authors.lastname: Cheng
authors.affiliation: Department of Hepatobiliary Surgery, Yue Bei People's Hospital, Shaoguan, Guangdong, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
keywords: hepatocellular carcinoma; liver resection; radiofrequency ablation; systematic review