title: Radiofrequency ablation combined with percutaneous ethanol injection for hepatocellular carcinoma: a systematic review and meta-analysis.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) are important treatments for patients with hepatocellular carcinoma (HCC) who are not eligible for resection and liver transplantation. Therefore, it is important to establish comparisons between RFA, PEI and the two therapies in combination.
  
  
  OBJECTIVE
  To evaluate the clinical efficacy and safety of combined RFA-PEI versus monotherapy with either RFA or PEI for HCC to provide references for clinical practice and further research.
  
  
  METHODS
  We searched all eligible studies published before September 2015 in the Cochrane Library, PubMed, Embase, Web of Science and Chinese databases, such as CBM, CNKI, VIP and WanFang and also retrieved papers from other sources. All relevant controlled trials were collected. Meta-analyses were performed using RevMan version 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark).
  
  
  RESULTS
  Thirteen trials with 1621 patients were identified. Compared with PEI, RFA was associated with significant improvement in overall survival (OS) rate at 1, 2, 3 and 4 years, cancer-free survival (CFS) rate at 1, 2 and 3 years and complete tumour necrosis. RFA was associated with a significant reduction in the local recurrence rate at 1, 2 and 3 years. However, RFA was also associated with a higher total risk of complications. Compared with RFA alone, combined RFA-PEI was associated with a significant improvement in the OS rate at 1.5, 2 and 3 years and a significant reduction in the local recurrence rate. However, combined RFA-PEI was also associated with a higher risk of fever.
  
  
  CONCLUSIONS
  The combination of RFA and PEI appears to be the optimal treatment strategy when considering combined RFA-PEI or either RFA or PEI alone. Combined RFA-PEI significantly improves OS and reduces the risk of local recurrence without increasing major complications. Further large-scale studies are needed to assess economic outcomes and quality of life.
authors.affiliation: a Department of General Surgery , First Clinical Medical College of Lanzhou University , Lanzhou , Gansu Province , PR China.|b Department of Oncology , Second People's Hospital of Gansu Province , Lanzhou , Gansu Province , PR China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Li
authors.affiliation: c Department of Infectious Disease , First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi Province , PR China.
authors.forename: Kai
authors.initials: K
authors.lastname: Zhang
authors.affiliation: c Department of Infectious Disease , First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi Province , PR China.
authors.forename: Shu-Mei
authors.initials: SM
authors.lastname: Lin
authors.affiliation: a Department of General Surgery , First Clinical Medical College of Lanzhou University , Lanzhou , Gansu Province , PR China.|b Department of Oncology , Second People's Hospital of Gansu Province , Lanzhou , Gansu Province , PR China.
authors.forename: Deng-Hai
authors.initials: DH
authors.lastname: Mi
authors.affiliation: a Department of General Surgery , First Clinical Medical College of Lanzhou University , Lanzhou , Gansu Province , PR China.
authors.forename: Nong
authors.initials: N
authors.lastname: Cao
authors.affiliation: b Department of Oncology , Second People's Hospital of Gansu Province , Lanzhou , Gansu Province , PR China.
authors.forename: Zhi-Zhen
authors.initials: ZZ
authors.lastname: Wen
authors.affiliation: b Department of Oncology , Second People's Hospital of Gansu Province , Lanzhou , Gansu Province , PR China.
authors.forename: Zhong-Xin
authors.initials: ZX
authors.lastname: Li
keywords: Hepatic carcinoma; meta-analysis; percutaneous ethanol injection; radiofrequency ablation; systematic review