Navigating the evidence for hepatocellular carcinoma treatment: Surgery vs radiofrequency ablation through sentiment and meta-analysis

Table 1 Overview of studies assessing outcomes of liver resection vs ablation in hepatocellular carcinoma

Ref.	Study type	Pre-PSM sample size	Post-PSM sample size	Subgroups	Subgroup type
Bai et al[10]	Retrospective comparative study	2197	1346	Yes	Microvascular invasion risk
Chong et al[11]	Retrospective comparative study	214	118	No
Chua et al[12]	Retrospective comparative study	219	104	No
Gory et al[13]	Retrospective comparative study	146		Yes	Tumor size (< 3 cm; < 5 cm)
He et al[14]	Retrospective comparative study	435	259	No
Hsiao et al[15]	Retrospective comparative study	387		No
Kim et al[16]	Retrospective comparative study	365	122	Yes	AFP level > 100 ng/mL (yes; no)
Lai et al[17]	Retrospective comparative study	94		Yes	Age (< 60 years; > 60 years)
Liu et al[19]	Retrospective comparative study	836	600	Yes	Risk of recurrence (high; low)
Liu et al[18]	Retrospective comparative study	237	158	No
Lu et al[20]	Retrospective comparative study	332	240	Yes	Milan criteria (yes; no) and recurrence within 2 years (yes; no)
Ng et al[21]	Randomized clinical trial	218		No
Qiu et al[22]	Retrospective comparative study	259	154	No
Song et al[24]	Retrospective comparative study	156		Yes	Tumor size (< 2 cm; 2-4 cm)
Song et al[23]	Randomized clinical trial	150		No
Takayasu et al[25]	Retrospective comparative study	853	732	No
Vitale et al[26]	Retrospective comparative study	720	693	No
Wang et al[27]	Retrospective comparative study	672	420	Yes	Age (60-64 years; 65-72 years; > 73 years)
Wei et al[28]	Retrospective comparative study	382		Yes	Pre-operatorial imaging traits
Xia et al[29]	Randomized clinical trial	217		Yes	Tumor size (< 3 cm; > 3 cm) and AFP > 200 ng/mL (yes; no)
Ye et al[30]	Retrospective comparative study	388	308	Yes	Tumor size (3-4 cm; 4-5 cm)
Zeng et al[31]	Retrospective comparative study	1632	1142	Yes	Tumor size (0-2 cm; 2-5 cm; > 5 cm) and age (< 65 years; > 65 years)
Zhong et al[32]	Retrospective comparative study	847	454	No

AFP: Alpha-fetoprotein; PSM: Propensity score matching.

Table 2 Summary of meta-analysis of adjusted hazard ratios for overall survival comparing liver resection and radiofrequency ablation

Ref.	Study type	Adjusted HR	95%CI lower	95%CI upper	Weight (%)	Treatment favored	Subgroup
Bai et al[10]	Retrospective comparative study	0.68	0.52	0.88	55.52	Resection	High risk MVI and Milan criteria
Bai et al[10]	Retrospective comparative study	0.47	0.26	0.84	11.17	Resection	High risk MVI size < 3 cm
Gory et al[13]	Retrospective comparative study	0.44	0.20	0.98	6.04	Resection	< 5 cm
He et al[14]	Retrospective comparative study	0.47	0.31	0.72	21.66	Resection	Total
Liu et al[18]	Retrospective comparative study	0.47	0.23	0.99	7.01	Resection	Total
Lu et al[20]	Retrospective comparative study	0.54	0.33	0.88	15.97	Resection	Total
Qiu et al[22]	Retrospective comparative study	0.57	0.41	0.83	30.88	Resection	Total
Takayasu et al[25]	Retrospective comparative study	0.82	0.46	1.45	11.66	No difference	Total
Vitale et al[26]	Retrospective comparative study	0.71	0.54	0.93	50.26	Resection	Total
Xia et al[29]	Randomized clinical trial	0.58	0.35	0.95	15.52	Resection	HCC > 3 cm
Xia et al[29]	Randomized clinical trial	0.54	0.34	0.87	17.19	Resection	AFP > 200 ng/mL
Zeng et al[31]	Retrospective comparative study	0.44	0.35	0.56	69.56	Resection	Age > 65 years
Zeng et al[31]	Retrospective comparative study	0.56	0.46	0.69	93.47	Resection	Age < 65 years
Zhong et al[32]	Retrospective comparative study	0.89	0.68	1.18	50.58	No difference	Total
Pooled estimate		0.59	0.54	0.65	100	Resection

HR: Hazard ratio; CI: Confidence interval; HCC: Hepatocellular carcinoma; MVI: Microvascular invasion; AFP: Alpha-fetoprotein.

Table 3 Excluded studies

Ref.	Study type	Treatment favored (OS)
Chong et al[11]	Retrospective comparative study	Resection
Chua et al[12]	Retrospective comparative study	Resection
Hsiao et al[15]	Retrospective comparative study	Resection
Kim et al[16]	Retrospective comparative study	No difference
Lai et al[17]	Retrospective comparative study	Resection/no difference
Liu et al[19]	Retrospective comparative study	Resection
Ng et al[21]	Randomized clinical trial	No difference
Song et al[24]	Retrospective comparative study	No difference
Song et al[23]	Randomized clinical trial	No difference
Wang et al[27]	Retrospective comparative study	Ablation/no difference
Wei et al[28]	Retrospective comparative study	Resection
Ye et al[30]	Retrospective comparative study	No difference/resection

OS: Overall survival.

Table 4 Baseline characteristics of the original patient population in the included studies before propensity score matching and/or subgroup analyses, mean ± avg for numerical ones, n (%)

Ref.	Age (years)	Sex	Child-Pugh/BCLC	Tumor size (cm)	MELD
Bai et al[10]	LR: 277 (20.6) > 60 years; RFA: 213 (24.9) > 60 years	LR: M = 1138 (84.6); RFA: M = 694 (81.3)	LR: Child-Pugh A = 1243 (92.4); RFA: Child-Pugh A = 694 (81.3)	LR: 690 (51.3) < 3 cm; RFA: 710 (83.2) < 3 cm
Gory et al[13]	LR: 59.3 ± 10.7; RFA: 65.1 ± 10.0	LR: M = 42 (81); RFA: M = 71 (74)	LR: Child-Pugh A = 46 (88.4); RFA: Child-Pugh A = 75 (78.1)	LR: 3.03 ± 1.08; RFA: 2.3 ± 0.96	LR: 8.4 ± 2.1; RFA: 10.1 ± 3.2
He et al[14]	LR: 47.4 ± 12.4; RFA: 53.9 ± 12.8	LR: M = 257 (83); RFA: M = 110 (88)	LR: Child-Pugh A = 305 (98); RFA: Child-Pugh A = 118 (94)	LR: 3.3 ± 1.0; RFA: 2.6 ± 1.0
Liu et al[18]	LR: 60 ± 13; RFA: 64 ± 12	LR: M = 78 (72); RFA: M = 84 (66)	LR: BCLC 0 = 109 (100); RFA: BCLC 0 = 128 (100)	LR: 109 (100) ≤ 2 cm; RFA: 128 (100) ≤ 2 cm	LR: 7.8 ± 1.3; RFA: 8.4 ± 2.5
Lu et al[20]	LR: 50.1 ± 10.9; RFA: 52.9 ± 11.8	LR: M = 124 (89.9); RFA: M = 172 (88.7)	LR: Child-Pugh A = 138 (100); RFA: Child-Pugh A = 194 (100)	LR: 2.8 ± 1.9; RFA: 1.9 ± 0.9
Qiu et al[22]	LR: 55.5 ± 12.9; RFA: 56.6 ± 11.2	LR: M = 98 (79.6); RFA: M = 118 (86.7)	LR: Child-Pugh = 5.8 ± 1.0; RFA: Child-Pugh = 6.1 ± 1.1	LR: 3.1 ± 1.3; RFA: 2.9 ± 1.1	LR: 9.2 ± 2.7; RFA: 10.7 ± 4.8
Takayasu et al[25]	LR: 139 (79) > 60 years; RFA: 397 (80.9) > 60 years	LR: M = 104 (59.1); RFA: M = 297 (60.5)	LR: Child-Pugh A = 151 (85.8); RFA: Child-Pugh A = 394 (80.2)	LR: 176 (100) ≤ 2 cm; RFA: 491 (100) ≤ 2 cm
Vitale et al[26]	LR: 132 (44.6) > 70 years; RFA: 129 (53.8) > 70 years	LR: M = 227 (76.7); RFA: M = 181 (75.4)	LR: Child-Pugh B = 28 (9.5); RFA: Child-Pugh B = 62 (25.8)	LR: 296 (100) ≤ 3 cm; RFA: 240 (100) ≤ 3 cm	LR: ≥ 8 = 199 (67.2); RFA: ≥ 8 = 170 (70.8)
Xia et al[29]	LR: 50.0 (24.0-58.0); RFA: 52.0 (25.0-59.0)	LR: M = 107 (89.2); RFA: M = 109 (90.8)	LR: Child-Pugh A = 120 (100); RFA: Child-Pugh A = 120 (100)	LR: 81 (67.5) < 3 cm; RFA: 78 (65.0) < 3 cm
Zeng et al[31]	LR: 66-75 years = 262 (65.0); RFA: 66-75 years = 152 (60.8)	LR: M = 281 (69.7); RFA: M = 172 (68.8)		LR: 180 (44.6) = 2-5 cm; RFA: 184 (73.6) = 2-5 cm
Zhong et al[32]	LR: 90 (29.3) ≥ 60 years; RFA: 184 (34.1) ≥ 60 years	LR: M = 245 (79.8); RFA: M = 482 (89.3)	LR: Child-Pugh A = 300 (97.7); RFA: Child-Pugh A = 523 (96.9)	LR: 135 (44.0) < 3 cm; RFA: 425 (78.7) < 3 cm

BCLC: Barcelona clinic liver cancer; LR: Liver resection group; RFA: Radiofrequency ablation group; MELD: Model of end stage liver disease; M: Male.

Table 5 Meta-analysis summary (overall survival)

Statistic	Value
Number of studies reviewed	23
Number of studies included in meta-analysis	11
Pooled hazard ratio	0.5924
95% confidence interval for hazard ratio	0.5404-0.6493
Heterogeneity (I²)	39.98%
Cochran’s Q statistic	21.66
P value for heterogeneity	0.0608
Model used	Random effects
Significance threshold	HR < 1 favors liver resection

HR: Hazard ratio.

Table 6 Summary of meta-analysis of adjusted hazard ratios for recurrence comparing liver resection and radiofrequency ablation

Ref.	Study type	Adjusted HR	95%CI lower	95%CI upper	Weight (%)	Treatment favored	Subgroup
Bai et al[10]	Retrospective comparative study	0.78	0.63	0.97	82.50	Resection	High risk MVI and Milan criteria
Bai et al[10]	Retrospective comparative study	0.51	0.32	0.81	17.81	Resection	High risk MVI e size < 3 cm
Gory et al[13]	Retrospective comparative study	0.48	0.28	3.52	2.42	No difference	< 5 cm
He et al[14]	Retrospective comparative study	0.43	0.31	3.2	2.75	No difference	Total
Liu et al[18]	Retrospective comparative study	0.41	0.26	3.8	2.12	No difference	Total
Qiu et al[22]	Retrospective comparative study	0.63	0.46	2.1	6.56	No difference	Total
Takayasu et al[25]	Retrospective comparative study	0.52	0.35	0.7	24.72	Resection	Total
Zeng et al[31]	Retrospective comparative study	0.43	0.32	0.56	49.07	Resection	Age > 65 years
Zeng et al[31]	Retrospective comparative study	0.57	0.45	0.73	65.65	Resection	Age < 65 years
Zhong et al[32]	Retrospective comparative study	0.68	0.57	0.82	116.19	Resection	Total
Pooled estimate		0.61	0.55	0.68	100	Resection

HR: Hazard ratio; CI: Confidence interval; MVI: Microvascular invasion.