Whether radiofrequency ablation (RFA) and liver resection (LR) are comparable treatments for early-stage hepatocellular carcinoma (HCC) is controversial. We conducted this study to provide ample clinical evidence for the argument. The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched to identify randomized controlled trials (RCTs) and propensity score-matched (PSM) studies that compared long-term outcomes of both RFA and LR for patients with early-stage HCC. The hazard ratios (HRs) with 95% confidence intervals (95% CI) of overall survival (OS) and disease-free survival (DFS) were calculated. Thirty-six studies consisting of six RCTs and 30 PSM studies were included in this study, and a total of 7384 patients were involved, with 3694 patients being treated with LR and 3690 patients with RFA. Meta-analysis showed that LR provided better OS and DFS than RFA (HR: 1.22, 95% CI: 1.13–1.31; HR: 1.56, 95% CI: 1.39–1.74, respectively). A sensitivity analysis indicated that the results were stable. For the subgroup of patients with BCLC 0 stage, RFA and LR resulted in similar OS and DFS. For the subgroup of patients with single tumor sizes less than 3 cm, RFA reached similar OS (HR: 1.19, 95% CI: 0.90–1.58) but worse DFS compared with LR (HR: 1.45, 95% CI: 1.11–1.90). For the subgroup of ablation margin larger than 0.5 cm, LR still resulted in better OS than RFA (HR: 1.29, 95% CI: 1.09–1.53); while the ablation margin was larger than 1 cm, both RFA and LR resulted in similar OS. The modality of RFA was also a factor that affected results. Subgroup analysis showed that patients receiving ultrasound-guided RFA had worse OS and DFS than LR (HR: 1.24, 95% CI: 1.14–1.36; HR: 1.44, 95% CI: 1.25–1.66, respectively). Meta-analysis showed that LR provided better OS and DFS for patients with early-stage HCC. However, RFA and LR had similar effects on long-term survival in patients with BCLC 0 stage HCC. RFA and LR probably had similar effects on OS in patients with solitary HCC less than 3 cm or when the ablation margin was larger than 1 cm which need more studies to confirm. The effects of different modalities of RFA on long-term survival are needed for further assessment.

中文翻译：

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肝切除与射频消融对早期肝细胞癌患者长期生存的比较：随机试验和高质量倾向评分匹配研究的荟萃分析

射频消融（RFA）和肝切除（LR）对于早期肝细胞癌（HCC）的治疗是否具有可比性尚存在争议。我们进行这项研究是为了为这一论点提供充足的临床证据。系统地检索了 PubMed、Embase、Web of Science 和 Cochrane 图书馆数据库，以确定随机对照试验 (RCT) 和倾向评分匹配 (PSM) 研究，这些研究比较了 RFA 和 LR 对早期癌症患者的长期结果肝癌。计算总生存期 (OS) 和无病生存期 (DFS) 的风险比 (HR) 和 95% 置信区间 (95% CI)。本研究纳入了 36 项研究，包括 6 项 RCT 和 30 项 PSM 研究，总共涉及 7384 名患者，其中 3694 名患者接受 LR 治疗，3690 名患者接受 RFA。荟萃分析显示，LR 比 RFA 提供更好的 OS 和 DFS（HR：1.22，95% CI：1.13–1.31；HR：1.56，95% CI：1.39–1.74）。敏感性分析表明结果稳定。对于 BCLC 0 期患者亚组，RFA 和 LR 产生相似的 OS 和 DFS。对于单肿瘤尺寸小于 3 cm 的患者亚组，RFA 达到相似的 OS（HR：1.19，95% CI：0.90–1.58），但与 LR 相比，DFS 较差（HR：1.45，95% CI：1.11–1.90） 。对于消融余量大于0.5 cm的亚组，LR仍比RFA获得更好的OS（HR：1.29，95％CI：1.09-1.53​​）；当消融边缘大于 1 cm 时，RFA 和 LR 的 OS 相似。RFA 的方式也是影响结果的一个因素。亚组分析显示，接受超声引导 RFA 的患者 OS 和 DFS 比 LR 差（HR：1.24，95% CI：1.14–1.36；HR：1.44，95% CI：1.25–1.66）。荟萃分析表明，LR 为早期 HCC 患者提供了更好的 OS 和 DFS。然而，RFA 和 LR 对 BCLC 0 期 HCC 患者的长期生存具有相似的影响。RFA 和 LR 可能对小于 3 cm 的孤立性 HCC 患者或当消融边缘大于 1 cm 的患者的 OS 产生类似的影响，这需要更多的研究来证实。不同射频消融方式对长期生存的影响需要进一步评估。