Background and aims: So far, no randomized trial or meta-analysis has been conducted on overall survival (OS) and recurrence-free survival (RFS) factors in patients treated with radiofrequency ablation (RFA) alone. The purpose of this meta-analysis was to evaluate prognostic factors of OS and RFS in patients treated with RFA.
Methods: A primary analysis was planned to evaluate the clinical prognostic factor of OS. RFS was the secondary aim. Thirty-four studies published from 2003 to 2017 were analyzed. They included 11,216 hepatocellular carcinoma patients.
Results: The results showed that Child–Pugh B vs Child–Pugh A (HR =2.32; 95% CI: 2.201–2.69;P<0.0001) and albumin–bilirubin score 1 vs 0 (HR =2.69; 95% CI: 2.10–3.44; P<0.0001) were predictive of poor OS. Tumor size as a continuous variable was not predictive of OS, although it was predictive of OS when we considered the size as a cutoff value (>2 cm vs <2 cm: HR =1.41; 95% CI: 1.23–1.61; P<0.0001; >3 cm vs <3 cm: HR =1.43; 95% CI: 1.17–1.74; P<0.0001) and in presence of >1 nodule (HR =1.59; 95% CI: 1.46–1.74; P<0.0001). Alpha-fetoprotein >20 ng/mL (HR =1.46; 95% CI: 1.25–1.70; P<0.0001) was the only predictive factor of poor prognosis.
Conclusion: Our meta-analysis highlighted that the maximum benefit of RFA in terms of OS and RFS is reached in the presence of Child–Pugh A, albumin–bilirubin score 1, single-nodule tumor sized <2 cm, and alpha-fetoprotein <20 ng/mL.

Keywords: radiofrequency, ALBI score, NLR, outcome, marker , immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-lymphocyte ratio, chil-pugh, alpha-fetoprotein 

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Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide.1 Hepatic resection and transplantation are considered the best treatments for early-stage patients with high probability of long-term survival.2 Radiofrequency ablation (RFA) is emerging as an effective local treatment for curative intent in patients with small HCC with a diameter <3 cm.3,4 Several meta-analyses5,6 have shown that RFA and surgical resection have a comparable impact on overall (OS) and recurrence-free survival (RFS). Given the different therapeutic options that occur in patients with HCC in the initial stage, it is absolutely essential to identify prognostic factors that can predict the possibility of relapse. There are several works published by RFA. All these studies have a heterogeneous duration of patient groups, to tell the reason, it is difficult to compare them. Furthermore, to date, neither randomized studies on RFA vs best supportive care nor meta-analyses evaluating OS and RFS have been completed on RFA patients alone.

The purpose of this meta-analysis was to evaluate prognostic factors of OS and RFS in patients treated with RFA, with the aim to identify parameters that can help clinicians in the therapeutic choice, and determine stratification factors for future studies in this subset of patients.