Radiofrequency Ablation of Hepatocellular Carcinoma: A Meta-analysis of Overall Survival and Recurrence-free Survival

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Resection and transplantation are considered the best treatments for early-stage hepatocellular carcinoma (HCC). Radiofrequency ablation is proving to be an effective local treatment for curative intent in some patients with HCC.

Patients with early-stage HCC have several therapeutic options, but choosing the ideal option lies with an accurate assessment of efficacy of the treatment and the risk of relapse. Studies and meta-analyses to date have compared radiofrequency ablation with surgery, whereas this meta-analysis focuses on only clinical or laboratory parameters. Its intent to determine prognostic factors for overall survival and recurrence-free survival in patients with HCC treated with radiofrequency ablation.

In this report, researchers share the results of a meta-analysis of more than 10,000 patients with HCC. Factors evaluated included Child-Pugh class, liver function parameters, number and size of nodules, and HBV and HCV status.

OncoTargets and Therapy
OncoTargets and Therapy

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 


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.  

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