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Loco-regional therapies competing with radiofrequency ablation in potential indications for hepatocellular carcinoma: A network meta-analysis

Jihyun An|Ju Hyun Shim|Seungbong Han|Ha Il Kim
대한간학회 (The korean Association for the Study of the Liver)|2023.10|Clinical and Molecular Hepatology|제29권 제4호|pp. 1013-1028

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키워드

Network meta-analysisSurvivalHepatocellular carcinomaRadiofrequency ablationLoco-regional treatment

초록

Background/Aims: There is no clear consensus on the relative ranking of interventional and radiation techniques with indications similar to those of radiofrequency ablation (RFA) for the treatment of early hepatocellular carcinoma (HCC). We used a network meta-analysis to compare the efficacy of non-surgical treatments for early HCC. Methods: We searched databases for randomized trials assessing the efficacy of loco-regional treatments for HCCs ≤5 cm with no extrahepatic spread or portal invasion. The primary outcome was the pooled hazard ratio (HR) for overall survival (OS), and secondary outcomes included overall and local progression-free survival (PFS). A frequentist network meta-analysis was performed, and the relative ranking of therapies was assessed with P-scores. Results: Nineteen studies comparing 11 different strategies in 2,793 patients were included. Chemoembolization plus RFA improved OS better than RFA alone (HR 0.52, 95% confidence interval [CI] 0.33–0.82; P-score=0.951). Cryoablation, microwave ablation, laser ablation, and proton beam therapy had similar effects on OS compared with RFA. For overall PFS, but not local PFS, only chemoembolization plus RFA performed significantly better than RFA (HR 0.61, 95% CI 0.42–0.88; P-score=0.964). Injection of percutaneous ethanol or acetic acid was significantly less effective than RFA for all measured outcomes, while no differences in progression outcomes were identified for other therapies included in the network. Conclusions: Our results suggest that chemoembolization combined with RFA is the best option for local treatment of early HCC. Cases with potential contraindications for RFA may benefit from a tailored approach using thermal or radiation modalities.

Abstract

Background/Aims: There is no clear consensus on the relative ranking of interventional and radiation techniques with indications similar to those of radiofrequency ablation (RFA) for the treatment of early hepatocellular carcinoma (HCC). We used a network meta-analysis to compare the efficacy of non-surgical treatments for early HCC. Methods: We searched databases for randomized trials assessing the efficacy of loco-regional treatments for HCCs ≤5 cm with no extrahepatic spread or portal invasion. The primary outcome was the pooled hazard ratio (HR) for overall survival (OS), and secondary outcomes included overall and local progression-free survival (PFS). A frequentist network meta-analysis was performed, and the relative ranking of therapies was assessed with P-scores. Results: Nineteen studies comparing 11 different strategies in 2,793 patients were included. Chemoembolization plus RFA improved OS better than RFA alone (HR 0.52, 95% confidence interval [CI] 0.33–0.82; P-score=0.951). Cryoablation, microwave ablation, laser ablation, and proton beam therapy had similar effects on OS compared with RFA. For overall PFS, but not local PFS, only chemoembolization plus RFA performed significantly better than RFA (HR 0.61, 95% CI 0.42–0.88; P-score=0.964). Injection of percutaneous ethanol or acetic acid was significantly less effective than RFA for all measured outcomes, while no differences in progression outcomes were identified for other therapies included in the network. Conclusions: Our results suggest that chemoembolization combined with RFA is the best option for local treatment of early HCC. Cases with potential contraindications for RFA may benefit from a tailored approach using thermal or radiation modalities.

참고문헌 (57)

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관련 논문AI추천

Chemoembolization versus Radiotherapy for Single Hepatocellular Carcinomas of ≤3 cm Unsuitable for Image-Guided Tumor AblationKim Euichang, Kim Jin Hyoung, Kim Sehee, Kim So Yeon, Lim Jihye, Shim Ju Hyun, Yoon Sang Min거트앤리버 소화기연관학회협의회 · Gut and Liver2024 · 제18권 제1호Combination transarterial chemoembolization and radiofrequency ablation therapy for early hepatocellular carcinoma배시현, 송명준, 윤승규, 이성원, 이준성, 최종영, Chan Ran You, Do Seon Song대한내과학회 · The Korean Journal of Internal Medicine2016 · 제31권 제2호Chemoembolization combined with radiofrequency ablation is the best option for the local treatment of early hepatocellular carcinoma?Hyo-Cheol Kim대한간학회 · Clinical and Molecular Hepatology2023 · 제29권 제4호Surgery versus radiofrequency ablation in patients with Child- Pugh class-A/single small (≤3 cm) hepatocellular carcinoma김영석, 서영주, Jin-Woo Lee, Jung Hwan Yu, Jung Hyun Kwon, Jungnam Lee, Oh Sang Kwon, Sang Gyune Kim, Seung Kak Shin, Soon Woo Nahm, Young-Joo Jin, Yujin Jeong대한간학회 · Clinical and Molecular Hepatology2022 · 제28권 제2호Role of Radiofrequency Ablation in Patients with Hepatocellular Carcinoma Who Undergo Prior Transarterial Chemoembolization: Long-Term Outcomes and Predictive Factors손원, 고광철, 곽금연, 백승운, 백용한, 유병철, 이준혁, 조주연, 최문석거트앤리버 소화기연관학회협의회 · Gut and Liver2014 · 제8권 제5호Recent technical advances in radiofrequency ablations for hepatocellular carcinomaDong Ho Lee소화기인터벤션의학회 · International Journal of Gastrointestinal Intervention2021 · 제10권 제4호

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