Overall survival and local recurrence following RFA, MWA, and cryoablation of very early and early HCC: a systematic review and Bayesian network meta-analysis

Objective To compare overall survival (OS) and local recurrence (LR) following radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) for very early and early hepatocellular carcinoma (HCC). Methods This systematic review was performed according to the PRISMA guidelines. MEDLINE, Embase, and Cochrane databases were searched. Randomized controlled trials (RCTs) and observational studies were included. OS and LR at 1 year and 3 years were assessed. OS was reported as hazard ratio (HR) with 95% credible intervals (CrI) and LR as relative risk (RR) with 95% CrI, to summarize effect of each comparison. Results Nineteen studies (3043 patients), including six RCTs and 13 observational studies, met inclusion criteria. For OS at 1 year, as compared to RFA, CA had HR of 0.81 (95% CrI: 0.43–1.51), and MWA had HR of 1.01 (95% CrI: 0.71–1.43). For OS at 3 years, as compared to RFA, CA had HR of 0.90 (95% CrI: 0.48–1.64) and MWA had HR of 1.07 (95% CrI: 0.73–1.50). For LR at 1 year, CA and MWA had RR of 0.75 (95% CrI: 0.45–1.24) and 0.93 (95% CrI: 0.78–1.14), respectively, as compared to RFA. For LR at 3 years, CA and MWA had RR of 0.96 (0.74–1.23) and 0.98 (0.87–1.09), respectively, as compared to RFA. Overall, none of the comparisons was statistically significant. Age of patients and tumor size did not influence treatment effect. Conclusions RFA, MWA, and CA are equally effective for locoregional treatment of very early and early HCC. Key Points • There is no significant difference in the OS and LR (at 1 year and 3 years) following ablation of very early and early HCC with RFA, MWA, and CA. • There was no effect of tumor size on the treatment efficacy. • More RCTs comparing CA with RFA and MWA should be performed.