A systematic review of radiofrequency ablation versus percutaneous ethanol injection for small hepatocellular carcinoma up to 3 cm

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background and Aim</jats:title><jats:p>Radiofrequency ablation (<jats:styled-content style="fixed-case">RFA</jats:styled-content>) and percutaneous ethanol injection (<jats:styled-content style="fixed-case">PEI</jats:styled-content>) have been used for patients with hepatocellular carcinomas (<jats:styled-content style="fixed-case">HCCs</jats:styled-content>) < 3 cm, but there is controversy which of the two methods is superior. Therefore, we aimed to conduct a systematic review to assess survival, complete tumor necrosis, recurrence and metastasis, major complications, costs, hospital stays, and posttreatment survival quality of <jats:styled-content style="fixed-case">RFA</jats:styled-content> versus <jats:styled-content style="fixed-case">PEI</jats:styled-content> for treating small <jats:styled-content style="fixed-case">HCCs</jats:styled-content> < 3 cm.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a search for published articles in <jats:styled-content style="fixed-case">P</jats:styled-content>ubMed, <jats:styled-content style="fixed-case">E</jats:styled-content>mbase, and the <jats:styled-content style="fixed-case">C</jats:styled-content>ochrane Library until <jats:styled-content style="fixed-case">M</jats:styled-content>arch 2012. Only randomized controlled trials (<jats:styled-content style="fixed-case">RCT</jats:styled-content>s) and quasi‐randomized clinical trials were included.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Four <jats:styled-content style="fixed-case">RCT</jats:styled-content>s with 766 patients were included in this review. We found that <jats:styled-content style="fixed-case">RFA</jats:styled-content> is significantly better than <jats:styled-content style="fixed-case">PEI</jats:styled-content> with respect to a 3‐year overall survival for small <jats:styled-content style="fixed-case">HCCs</jats:styled-content> (<jats:styled-content style="fixed-case">RFA</jats:styled-content> <jats:italic>vs</jats:italic> <jats:styled-content style="fixed-case">PEI</jats:styled-content>, hazard ratios [<jats:styled-content style="fixed-case">HR]</jats:styled-content> = 0.66, 95% confidence interval [<jats:styled-content style="fixed-case">CI]</jats:styled-content>: 0.48–0.90, <jats:italic>P</jats:italic> = 0.009), especially for <jats:styled-content style="fixed-case">HCCs</jats:styled-content> > 2 cm (<jats:styled-content style="fixed-case">HR</jats:styled-content> = 0.56, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content>: 0.31–0.99, <jats:italic>P</jats:italic> = 0.045). <jats:styled-content style="fixed-case">RFA</jats:styled-content> had a lower risk of local recurrence (<jats:styled-content style="fixed-case">HR</jats:styled-content> = 0.38, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content>: 0.15–0.96, <jats:italic>P</jats:italic> = 0.040), but no difference is seen for distant intrahepatic recurrence. <jats:styled-content style="fixed-case">RFA</jats:styled-content> had higher rates of complete tumor necrosis, but <jats:styled-content style="fixed-case">RFA</jats:styled-content> also caused more major complications and was more costly than <jats:styled-content style="fixed-case">PEI</jats:styled-content>. <jats:styled-content style="fixed-case">B</jats:styled-content>egg's and <jats:styled-content style="fixed-case">E</jats:styled-content>gger's tests detected no significant publication bias among the four <jats:styled-content style="fixed-case">RCT</jats:styled-content>s.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p><jats:styled-content style="fixed-case">RFA</jats:styled-content> appears superior to <jats:styled-content style="fixed-case">PEI</jats:styled-content> with respect to local tumor control and 3‐year survival for small <jats:styled-content style="fixed-case">HCCs</jats:styled-content> < 3 cm. <jats:styled-content style="fixed-case">RFA</jats:styled-content> was more feasible in patients with <jats:styled-content style="fixed-case">HCCs</jats:styled-content> > 2 cm or <jats:styled-content style="fixed-case">C</jats:styled-content>hild–<jats:styled-content style="fixed-case">P</jats:styled-content>ugh <jats:styled-content style="fixed-case">A</jats:styled-content> liver function.</jats:p></jats:sec>