Systematic review of surgical resection vs radiofrequency ablation for hepatocellular carcinoma

Table 3 Characteristics of randomized controlled studies that compared hepatic resection vs radiofrequency ablation

Ref.	Liver function	Tumor features	Treatment	Study characteristics and main findings
Chen et al[33]	Child-Pugh class AICG-R15 < 30%PLT > 40000/mm3	Single < 5 cm	HR: 90RFA: 71	21% of patients randomized to RFA withdrew their consent. The 1-, 3-, and 4-year overall survival rates after RFA and surgery were 95.8%, 71.4%, 67.9% and 93.3%, 73.4%, 64.0%, respectively. The corresponding DFS rates were 85.9%, 64.1%, 46.4% and 86.6%, 69%, 51.6%, respectively. Statistically, there was no difference. The 5-year rates were not reported
		Single tumor ≤ 3 cm	HR: 42RFA: 37	Authors stated that patient survival and DFS did not change in tumors < 3 cm but survival rates and P-values were not provided (only Kaplan-Meier curves were reported)
		Single 3.1-5.0 cm	HR: 48RFA: 34	Authors stated that patient survival and DFS did not change in tumors between 3.1 and 5.0 cm but survival rates and P-values were not provided (only Kaplan-Meier curves were reported)
Huang et al[34]	Child-Pugh class A/BICG-R15 < 20%PLT > 50000/mm3	Single ≤ 5 cm or up to 3 nodules < 3 cm	HR: 115RFA: 115	Despite randomization, RFA patients had higher prevalence of nodules ≤ 3 cm (P = 0.021). The 3- and 5-year survival rates for the RFA group and the HR group were 69.6%, 54.8% and 92.2%, 75.7%, respectively (P = 0.001). The corresponding RFS rates were 46.1%, 28.7% and 60.9%, 51.3%, respectively (P = 0.017)
		Single tumor ≤ 3 cm	HR: 45RFA: 57	The 3- and 5-year survival rates for the RFA group and the HR group were 77.2%, 61.4% and 95.6%, 82.2%, respectively (P = 0.030). Neither DFS nor RFS for this subgroup were provided
		Single 3.1-5.0 cm	HR: 44RFA: 27	The 3- and 5-year survival rates for the RFA group and the HR group were 66.7%, 51.5% and 95.5%, 72.3%, respectively (P = 0.046). Neither DFS nor RFS for this subgroup were provided
		Multifocal < 3 cm	HR: 26RFA: 31	The 3- and 5-year survival rates for the RFA group and the HR group were 58.1%, 45.2% and 80.8%, 69.2%, respectively (P = 0.042). Neither DFS nor RFS for this subgroup were provided
Feng et al[35]	Child-Pugh class A/BICG-R15 < 30%PLT > 50000/mm3	Up to 2 nodules < 4 cm	HR: 84RFA: 84	The 1- and 3-year survival rates for HR and RFA groups were 96.0%, 74.8% and 93.1%, 67.2%, respectively (P = 0.342). The corresponding RFS rates were 90.6%, 61.1% and 86.2%, 49.6%, respectively (P = 0.122). Results at 5-year not reported (or not reached). On the basis of this lack of evidence, the authors did not include treatment as a variable in multivariate analysis

Other inclusion criteria common to all randomized controlled trials (RCTs): no radiological evidence of invasion into the portal/hepatic vein branches, no extra-hepatic metastases, no previous treatment of hepatocellular carcinoma (HCC), patient should be suitable to be treated by surgical resection and radiofrequency ablation. HR: Hepatic resection; RFA: Radiofrequency ablation; DFS: Disease-free survival; PLT: Platelet.