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

Background and Aim Radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) have been used for patients with hepatocellular carcinomas (HCCs) <3cm, 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 RFA versus PEI for treating small HCCs <3cm. Methods We conducted a search for published articles in PubMed, Embase, and the Cochrane Library until March 2012. Only randomized controlled trials (RCTs) and quasi-randomized clinical trials were included. Results Four RCTs with 766 patients were included in this review. We found that RFA is significantly better than PEI with respect to a 3-year overall survival for small HCCs (RFAvsPEI, hazard ratios [HR]=0.66, 95% confidence interval [CI]: 0.480.90, P=0.009), especially for HCCs >2cm (HR=0.56, 95% CI: 0.310.99, P=0.045). RFA had a lower risk of local recurrence (HR=0.38, 95% CI: 0.150.96, P=0.040), but no difference is seen for distant intrahepatic recurrence. RFA had higher rates of complete tumor necrosis, but RFA also caused more major complications and was more costly than PEI. Begg's and Egger's tests detected no significant publication bias among the four RCTs. Conclusions RFA appears superior to PEI with respect to local tumor control and 3-year survival for small HCCs <3cm. RFA was more feasible in patients with HCCs >2cm or ChildPugh A liver function.