Unraveling the Controversy: Transarterial Chemoembolization versus Radiofrequency Ablation in Early Hepatocellular Carcinoma - A Systematic Review and Meta-Analysis

Unraveling the Controversy: Transarterial Chemoembolization versus Radiofrequency Ablation in Early Hepatocellular Carcinoma - A Systematic Review and Meta-Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unraveling the Controversy: Transarterial Chemoembolization versus Radiofrequency Ablation in Early Hepatocellular Carcinoma - A Systematic Review and Meta-Analysis Mahmoud Shaban Abdelgalil, Bahaa Elfakharany, Mohamed El-Samahy, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3372637/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Patients with hepatocellular carcinoma (HCC) may face challenges when undergoing radiofrequency ablation (RFA) if their tumors are located near critical liver regions, bile ducts, bowel lumen, or diaphragm due to increased risk of complications. In these cases, liver resection or transplantation is not possible; therefore, transarterial chemoembolization (TACE) can be an alternative treatment for early HCC patients. Our study aims to compare the efficacy and safety of TACE versus RFA. Methods We collected data from different sources, including Cochrane Library, PubMed, Scopus, and Web of Science. Our inclusion criteria were patients with a single tumor less than 5 cm or three tumors, each less than or equal to 3 cm in size, without spread or invasion. The review examined various factors such as overall survival (OS), recurrence-free survival rate (RFS), progression-free survival (PFS), tumor response (TR), and adverse event rate (AER). Results Eighteen studies, involving 4,537 patients were reviewed. Pooled analysis revealed that RFA had better three-year and five-year OS rates compared to TACE (RR = 0.85, 95% CI [0.78, 0.92], p < 0.00001; RR = 0.80, 95% CI [0.73, 0.89], p < 0.0001, respectively). However, for one-year OS, no significant difference was observed, except in specific subgroups (patients aged ≥ 60 years, AFP ≥ 100 ng/ml, or received Adriamycin), where RFA showed better outcomes (RR = 1.02, 95% CI [0.99, 1.05], p = 0.29). Propensity score-matching analyses also demonstrated better three-year and five-year OS rates for RFA (RR = 0.91, 95% CI [0.85, 0.96], p = 0.001; RR = 0.85, 95% CI [0.79, 0.92], p < 0.001, respectively). Trans Arterial Chemoembolization Radiofrequency Ablation Hepatocellular carcinoma Early HCC Liver cancer Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 1. Introduction Liver cancer remains a pressing concern for global health, with more than 1 million cases anticipated by 2025 ( 1 ). Globally, liver cancer ranks as the sixth most prevalent cancer, with 905,700 new cases reported in 2020 ( 2 ), and is the fourth leading cause of cancer-related mortality worldwide ( 1 ). Approximately 90% of liver cancer cases are attributed to hepatocellular carcinoma (HCC) ( 1 ). HCC has the highest prevalence and mortality rates in East Asia and Africa, with rising incidence and mortality observed in various regions of Europe and the USA ( 3 ). Since the early 2000s, HCC has been the fastest-growing cause of US cancer-related deaths, as reported by the Surveillance Epidemiology End Results. If these trends persist, it may become the third leading cause of cancer mortality by 2030 ( 4 ). HCC is closely linked to chronic liver disease, particularly cirrhosis, which is responsible for more than 90% of HCC cases. Several notable predictors of HCC development, containing chronic alcohol consumption, diabetes, nonalcoholic steatohepatitis (NASH) associated with obesity, as well as infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). Additionally, although less common, HCC can also arise from cirrhosis caused by primary biliary cholangitis, hemochromatosis, or α1-antitrypsin deficiency ( 1 ). The optimal treatment choices for HCC are liver transplantation or resection. However, Non-surgical treatment options are commonly utilized in real-world practice for patients with HCC, often due to tumor burden, hepatic functional reserves, organ donor availability, surgical risks, and patient preferences. The recommended HCC nonsurgical options in these situations include radiofrequency ablation (RFA) and Trans arterial chemoembolization (TACE) ( 5 , 6 ). RFA employs a catheter tip to deliver a high-frequency alternating current, resulting in tissue necrosis within a 1.5 cm radius induced by thermal energy. RFA is considered the primary treatment option for individuals with very early-stage HCC, defined as a single tumor with a diameter smaller than 2 cm. It is also recommended as an early-stage HCC substitute treatment, which includes a single tumor sized 5 cm or 3 nodules sized < 3 cm. RFA is favored in these cases due to its less invasive nature and better tolerability when compared to hepatic resection ( 5 – 8 ). However, RFA has high post-procedural recurrence rates, reaching 70% at 5 years, impacting the long-term survival of these patients ( 9 ). In addition, RFA may not be feasible in cases where tumors are located in specific liver regions or close to the diaphragm, bowel lumen, or bile duct, as it increases bleeding, perforation, or bile leakage as complications ( 10 , 11 ). In situations where resection and transplantation of the liver aren’t possible choices, TACE may be a feasible substitute ( 12 , 13 ). TACE induces tumor ischemia and facilitates the local delivery of chemotherapeutic agents through the hepatic artery via the infusion of chemotherapy agents. Although retrospective cohort studies have provided evidence of satisfactory survival outcomes for naïve patients treatment who diagnosed with early-stage HCC, TACE is predominantly enhanced as a comforting therapeutic method for HCC patients in intermediate-to-advanced stage ( 12 – 14 ). Multiple studies have compared TACE and RFA in patients with HCC, using the Milan criteria ( 12 – 14 ). According to a study conducted by Hsu et al. in 2011, comparable overall survival rates were observed between TACE and RFA. However, RFA demonstrated superior outcomes specifically for small tumors with a total tumor volume of less than 11 cm3. ( 14 ). Though, additional articles have detected comparable overall survival and tumor response/recurrence rates between TACE and RFA in small tumors ( 13 , 15 ). In contrast, guidelines recommend RFA for early HCCs < 3 cm and TACE for intermediate ones.Real-world factors involving patients and tumors often hinder strict compliance with these guidelines ( 16 ). With the contradictory findings in the literature regarding TACE in tumors small sized and the existing medical practice guiding principle advocating for < 3 cm sized HCCs ablation, there is a need to carefully consider the best treatment approach, so we aimed to conduct this systematic review and meta-analysis to compare the safety and efficacy of TACE as a substitute to RFA for HCC patients in early-stage. 2. Methods In conducting our study and presenting our findings, we followed the prescribed writing rules for systematic reviews and meta-analyses, namely the PRISMA 2020 ( 17 ) and Cochrane Handbook of Systematic Reviews of Intervention ( 18 ). Additionally, we registered our meta-analysis protocol in PROSPERO under the identifier "CRD42023414662." 2.1. Literature search We used Cochrane Library, PubMed, Web of Science, and Scopus databases for searching the literature, with a search period from inception to January 31, 2023. The detailed search strategy and terms related to “trans-arterial chemoembolization”, “radiofrequency ablation”, and “hepatocellular carcinoma (HCC)” are provided in Supplementary File S1 . 2.2. Eligibility Criteria and Study Selection Two authors, S A, and B E, assessed articles to determine whether they met the inclusion criteria. Their evaluation focused on randomized controlled trials (RCTs), non-randomized comparative studies, and observational studies (prospective and retrospective cohort studies) that investigated the clinical efficacy and safety of TACE in comparison with RFA in participants diagnosed with early HCC, which is defined as a solitary nodule < 5 cm or three nodules ≤ 3 cm in size, deprived of extrahepatic spread or vascular invasion. Additionally, a third author served as an arbitrator to resolve discrepancies between the original authors. 2.3. Exclusion criteria The following studies were excluded; 1) Studies with larger tumor sizes or with other HCC stages were excluded. 2) Other study designs, such as cross-sectional studies, case series, case reports, editorials, and non-human studies because of increased publication bias risk. We also excluded conference abstracts. 2) Different treatment modalities such as surgery or percutaneous ethanol injection. 3) Studies did not compare TACE and RFA as primary interventions. 4) Studies were not published in English. Or 5) Studies had unreliable extracted data for investigation. 2.4. Quality assessment The assessment of the quality of the involved cohort studies was conducted using the Newcastle-Ottawa Scale (NOS) ( 19 ). The NOS comprises three domains, namely selection, comparability, and outcomes. A total score of 9 can be achieved on the NOS. A NOS score of 7 or higher was deemed indicative of high quality. Two independent authors rated the quality separately and resolved discrepancies through discussion, or with a third reviewer as an arbitrator. 2.5. Data Extraction and Study Outcomes Four authors independently performed data extraction using a standardized methodology. In cases of disagreement, the discrepancies were resolved through discussion or by consulting the senior author. The initial screening of studies for potential inclusion was based on the title and abstract, followed by a thorough full-text review of included studies. Relevant data were extracted from each study into a predefined Excel spreadsheet. A concise overview of the prominent characteristics of the studies, descriptions of the patients who were enrolled, and the outcomes of TACE and RFA in terms of safety and efficacy, were extracted. Data extraction was conducted either through in-text descriptions or by visual estimation from Kaplan-Meier survival curves at specific time points (1-, 3- and 5-year). 2.6. Outcome definition This study assessed treatment efficacy based on multiple outcomes, including overall survival (OS) (defined as the time from treatment initiation to death or last follow-up), recurrence-free survival rate (RFS) (patients proportion without hepatocellular carcinoma recurrence), progression-free survival (PFS) (patients proportion without disease progression), tumor response (TR) (patients proportion through a whole, fractional, constant, or advanced response), and adverse event rate (AER) (patients proportion with treatment-related adverse events). Propensity-score matching (PSM) cohort analysis detected rates of overall survival and recurrence-free survival, representing the proportions of patients alive after therapy initiation and those remaining free of HCC recurrence, respectively. 2.7. Data Synthesis and Heterogeneity Assessment Revman software Version 5.4.1 was employed to conduct all statistical analyses. The combined risk ratio (RR) was computed for dichotomous data, while the continuous one was expressed by the mean difference (MD) as well as confidence intervals (CI 95%) for both. To ascertain statistical significance and heterogeneity, a p-value was used. It was less than 0.05 and 0.10 indicating significance and heterogeneity, respectively. If heterogeneity was found, a random-effects model was used, and a leave-one-out test was performed to determine which study was responsible for heterogeneity. ( 20 ) 3. Results 3.1. Literature search results A comprehensive search across various databases, such as PubMed, Web of Science, Cochrane Library, and Scopus, yielded a total of 2543 studies. Among them, 711 duplicates were identified and subsequently removed. Through a thorough assessment of titles and abstracts, 1817 publications were omitted because they didn’t fulfill our study inclusion criteria. Following this initial screening, 20 full-text researchers were carefully assessed to determine their suitability. Ultimately, about 18 studies were comprised of our meta-analysis, as depicted in Fig. 1 . 3.2. Summary of the included studies The meta-analysis included 4537 patients, with 2449 patients receiving TACE and 2088 patients receiving RFA. The age range of the patients in this study was 57–71 years. The studies were conducted in various settings and geographical locations, offering a diverse range of evidence for meta-analysis. Table 1 presents a comprehensive summary of the trials that were included in this study, offering a detailed overview of their key aspects. On the other hand, Table 2 provides insightful information regarding the baseline characteristics of the patients involved in these trials. Table 1 comprehensive overview of the included studies Study ID Study design, country, study duration Sample size of each group Criteria Type of TACE Tace dose Conclusion Chok et al. 2006 Retrospective cohort, Hong Kong, (2001–2004). TACE (n = 268), RFA (n = 136) • Age ≥ 19 years • Presence of measurable lesion according to mRECIST • Single tumors sized up to 5 cm or up to three nodules measuring ≤ 3 cm • ECOG performance status 0–2, • Platelet count ≥ 50×103/µL • Serum alanine aminotransferase levels (ALT) < 10 times the upper limit of normal. cTACE Adriamycin 30 mg − 50 mg RFA and TACE were equally effective in treating patients with unresectable hepatocellular carcinoma (HCC) in terms of survival outcomes. Yang Hsu et al. 2011 Retrospective cohort PSM, Taiwan, (2002–2010) TACE (n = 215), RFA (n = 315) • Caudate HCC within the Milan criteria. • Milan criteria included one lesion ≤ 5 cm or 2–3 lesions ≤ 3 cm each without vascular invasion or extrahepatic spread. cTACE Adriamycin 20 to 30 mg of Patients with a smaller TTV (< 11 cm3) are likely to benefit more from RFA treatment. Yang et al. 2014 Retrospective cohort, Korea, (2005–2013) . TACE (n = 66), RFA (n = 79) • Single-nodule HCC was smaller than or equal to 3 cm without vascular invasion. • Who were treated initially with HR, RFA, or TACE cTACE Doxorubicin hydrochloride mitomycin TACE is effective in achieving comparable long-term survival rates to HR and RFA for small single-nodule hepatocellular carcinoma. Kim et al. 2014 Retrospective cohort, South Korea, (2005–2015) TACE (n = 122), RFA (n = 165) • Single HCC with the largest diameter of 2 cm or less, no vascular invasion, and no extrahepatic disease were initially treated with TACE or RFA. • Patients refusing surgery due to age, finances, or preference and those ineligible for surgery due to hepatic function or comorbidities were included. • Patients with unpredictable transplantation times during the liver transplantation waiting period were also included. cTACE 0.5 Cisplatin mg / ml in distilled water at a dose of 2 mg / kg of patient weight (4 ml / kg). TACE may be a viable alternative treatment for ≤ 2 cm HCCs when RFA is not feasible. Liu et al. 2014 Retrospective cohort PSM, Taiwan, (2002–2013). TACE (n = 282) RFA (n = 424) • Patients within the Milan criteria who received RFA or TACE as their primary treatment cTACE Adriamycin 20–30 mg For HCC patients within the Milan criteria with a performance status of 0, RFA provides better long-term survival than TACE. SONG et al. 2016 Retrospective cohort, Korea (2004–2010) TACE (n = 71), RFA (n = 43) • Single HCC ≤ 5 cm or up to three HCCs ≤ 3 cm, • At least two HCC lesions of a minimum of 10 mm in diameter based on liver dynamic CT with target lesions suitable for accurate repeated measurements, • ECOG performance status of 0 or 1, • Preserved liver function (Child-Pugh Class A or B), • No previous treatment for HCC • No vascular invasion selective TACE Doxorubicin hydrochloride 50 mg/m2 TACE + RFA combination treatment has favorable local recurrence and improved overall survival rates in early-stage HCC patients, especially for tumors < 3 cm.. Chen et al. 2016 Retrospective cohort PSM, China, (2007–2011) TACE (n = 311)), RFA (n = 338) • Confirmed diagnosis of HCC (by biopsy or clinical criteria) • BCLC stage 0/A HCC (single tumor < 5 cm or up to three tumors ≤ 3 cm) • initial treatment with TACE or RFA, TACE is considered an alternative treatment for unsuitable cases • Eastern Cooperative Oncology Group performance status of 0–1 • Child-Pugh liver function score of A/B. cTACE 5-fluorouracil 1.0 g Oxaplatin 150 mg, Mitomycin C 10 mg Trans-arterial chemoembolization is an effective alternative treatment for unresectable BCLC stage 0/A HCC when RFA is not feasible. Hocquelet et al. 2016 Retrospective cohort, France, (2004–2013) TACE (n = 61), RFA (n = 61) • Consecutive cirrhotic patients with single HCC ≤ 5 cm or up to three nodules ≤ 3 cm are unsuitable for surgery without extrahepatic metastasis. • Based on local tumor board decisions, patients were treated with first-line RFA or supra-selective Tace. • Child-Pugh A liver function and no other cancer. selective TACE doxorubicin hydrochloride (50mg in 10 ml) For Child-Pugh A patients with early-stage HCC, using supra-selective TACE instead of RFA, which is challenging with common US guidance, leads to decreased local tumor control and overall survival Lee et al. 2017 Retrospective cohort, Korea, (2008–2013) TACE (n = 150), RFA (n = 36) • HCC patients with BCLC stages 0, B, C, D, • undetermined BCLC stage, multiple (≥ 2) tumor • tumor size of 3 cm or > 5 cm N/A N/A RFA has better OS and PFS rates than TACE, respectively, but similar OS and PFS rates compared with SR, respectively, for single 3 to 5 cm sized HCC with BCLC stage A. Ishikawa et al. 2018 Retrospective cohort PSM, Japan (2009–2014) TACE (n = 32), RFA (n = 210) • HCC patients who diagnosed regarding the American Association for the Study of Liver Diseases criteria. patients in BCLC stage 0/A within the Milan criteria. cTACE miriplatin 120 mg TACE can substitute RFA at least in some patients with BCLC 0/A HCC. Lee et al. 2018 Retrospective cohort, Taiwan, (2005–2016) TACE (n = 31), RFA (n = 43) • Caudate HCC within the Milan criteria (one lesion ≤ 5 cm or 2–3 lesions ≤ 3 cm each without vascular invasion or extrahepatic spread). • All the patients in this study had only one HCC in the caudate lobe. cTACE doxorubicin hydrochloride 10–40 mg RFA appears to outperform TACE for patients with caudate HCC within the Milan criteria and should be the favored treatment option when surgical resection is not feasible. MARTIN et al. 2019 Retrospective cohort, USA, (2005–2014) TACE (n = 27) RFA (n = 27) • Adult patients ≥ 18 years diagnosed with solitary HCC ≤ 3 cm selective TACE Doxorubicin RFA has better OS and PFS rates than TACE, respectively, but similar OS and PFS rates compared with SR, respectively, for single 3 to 5 cm sized HCC with BCLC stage A. Chu et al. 2019 Retrospective cohort PSM, South Korea, (2000–2016) TACE (n = 314), RFA (n = 115) • Single medium-sized (3.1–5-cm) HCC. cTACE cisplatin 2 mg/kg body weight Chemoembolization plus RF ablation may provide better survival outcomes than chemoembolization or RF ablation monotherapy, and can be considered a viable alternative treatment for unresectable single medium-sized HCCs. Yun et al. 2020 Retrospective cohort, Korea (2005–2016) TACE (n = 268), RFA (n = 136) • Age ≥ 19 years • Presence of measurable lesion according to mRECIST • Single tumor ≤ 5 cm or up to three nodules ≤ 3 cm, • ECOG performance status 0–2 • platelet count ≥ 50×103/µL • ALT levels < 10x upper limit of normal cTACE Adriamycin (50 mg-30 mg) TACE could be an effective alternative to RFA in terms of the 5-year OS rate for early-stage HCC. However, TACE should be confined only to RFA-difficult cases, given its lower CR and RFS rates and risk of deterioration in the liver function after treatment, as compared with RFA Hyun Oh et al. 2020 Retrospective cohort, Korea , (2009–2013) RFA (n = 87), TACE (n = 141) • Milan criteria defined by 2–3 nodules and tumor size ≤ 3 cm without vascular invasion, bile duct invasion, or extrahepatic metastasis N/A N/A Chemoembolization plus RF ablation may provide better survival outcomes than chemoembolization or RF ablation monotherapy, and can be considered a viable alternative treatment for unresectable single medium-sized HCCs. Kim et al. 2021 pilot non-randomized trial, Korea, (2010–2017) TACE (n = 21) RFA (n = 19) • Treatment-naïve HCC, • Child-Pugh class A or B, • ECOG performance status 0–2, • absence of main portal vein thrombosis and extrahepatic metastases, • high risk for surgery or refusal of surgery despite clinician's advice. DEB-TACE doxorubicin (50 or 75 mg) DEB-TACE or RFA were similar. DEB-TACE could be applied selectively in patients with a single small HCC if the other therapeutic modality is unfeasible. Tay et al. 2022 Retrospective cohort, Singapore, (2010–2014) TACE (n = 168), RFA (n = 56) • Patients treated with either TACE or RFA as the first line monotherapy for Barcelona Clinic Liver Cancer (BCLC) stage 0, A or B HCC cTACE Cisplatin, Doxorubicin or Adriamycin. Patients with early-stage HCC, both TACE and RFA led to similar overall survival and recurrence rates. This suggest that TACE may be considered as an alternative treatment option in patients unsuitable for surgery and/or RFA. Yein Ho et al. 2022 Retrospective cohort, Taiwan, (2002–2017) TACE (n = 337) RFA (n = 546), • HCC with single tumor up to 5 cm or two to three nodules less than 3 cm, without vascular invasion or extrahepatic metastasis cTACE Adriamycin 20–30 mg TBS is a feasible prognostic predictor in HCC patients within the Milan criteria. TACE may be an effective treatment alternative for these patients. Among patients with low TBS, RFA should be considered the priority treatment modality. Abbreviations: HCC (hepatocellular carcinoma) BCLC ( Barcelona Clinic Liver Cancer staging system) TBS (tumor burden score) TTV (total tumor volume) RFA (radiofrequency ablation) SR (surgical resection) TACE (trans-arterial chemoembolization) Ctace (conventional trans arterial chemoembolization) DEB-TACE (drug-eluting bead trans arterial chemoembolization) PSM (propensity score matching) OS (overall survival) ECOG, (Eastern Cooperative Oncology Group) PFS, (progression-free survival rate) RFS (recurrence-free survival rate). Table 2 Baseline characteristics of enrolled patients in each included studies study ID Groups number of patients n (%) Age Males n (%) Maximal tumor size Platelet count,X(10)9/L Total bilirubin level, mg/dL alpha-Fetoprotein level, ng/mL HBV n (%) HCV n (%) ALCOHOLIC n (%) Tumor number solitary/multiple n (%) Chok et al. 2006 TACE 40 66 (47–85) 28(70) 33 104.7 0.25 646 31/40 (78) N/A N/A N/A RFA 51 62 (42–77) 38(76) 30 116.5 0.23 495 42/51 (82) N/A N/A N/A Yang Hsu et al. 2011 TACE 215 68 ± 10 205 (65) 76 (35) N/A 1.06 ± 0.6 1629 ± 18,276 89 (41) 103 (48) 22 (10) 24 / 8 RFA 315 67 ± 11 152 (71) 68 (22) N/A 1.05 ± 1.0 293 ± 1277 153 (49) 138 (44) 30 (10) 150 /60 Yang et al. 2014 TACE 66 59.0 ± 9.5 49(74.2) N/A 113 ± 62 1.14 ± 0.54 N/A 46 18 N/A N/A RFA 79 57.2 ± 9.2 59(74.68) N/A 112 ± 52 1.27 ± 0.71 N/A 56 13 N/A N/A Kim et al. 2014 TACE 122 56.3 ± 9.4 98(80.3) 16 ± 4 N/A N/A N/A 89 (73) 18 (14.7) 11 (9) N/A RFA 165 57.7 ± 8.9 123(74.54) 16 ± 3 N/A N/A N/A 116 (70.3) 23 (14) 16 (9.6) N/A Liu et al. 2014 TACE 282 67.70 ± 10.30 192(68.08) N/A N/A 1.16 ± 0.83 1348.7 ± 16050.78 119 134 38 136/64 RFA 424 66.256 ± 11.52 278(65.56) N/A N/A 1.07 ± 1.08 307.31 ± 1315.55 198 177 69 159/41 SONG et al. 2016 TACE 71 60 (23 − 87.2) 53(74.64) N/A 110 ± 50 1.2 ± 1.9 24.9 (1.7–25,714.0) 49 14 N/A 41/30 RFA 43 62 (35–88) 31(72.09) N/A 114 ± 57 1.27 ± 1.4 14.4 (1.9–1,210.0) 28 9 N/A 35/8 Chen et al. 2016 2016 TACE 311 ≤ 58 N = 160 > 58 N = 151 174(55.94) N/A N/A N/A N/A 194 9 N/A 84/19 RFA 338 ≤ 58 N = 167 > 58 N = 171 181(53.55) N/A N/A N/A N/A 217 14 N/A 80/23 Hocquelet et al. 2016 TACE 61 67 ± 11 47 (77) 31 (10) 121 (81–160) N/A 10 (4–43) N/A 14 (23) N/A 42/19 RFA 61 67 ± 11 50 (82) 30.2 (10) 122 (86–162) N/A 10 (5–42) N/A 13 (21) N/A 47/14 Lee et al. 2017 TACE 150 64 ± 8.1 111 (74.0) 40 (31–50) 115 (33–461) 0.9 (0.2–3.5) 26.9 (1–3.5104) 94 (62.7) 2 (5.6) 13 (8.7) N/A RFA 36 62.5 ± 12.5 29 (80.56) 38 (31–50) 136 (19–287) 0.8 (0.1–1.6) 11.9 (1–1.3104) 24 (66.7) 13 (8.7) 6 (16.7) N/A Ishikawa et al. 2018 TACE 32 71 (48–88) 19(59.37) 26 (8–45) 10.1 (2.8–34.3) 1.1 (0.4–2.4) 15.0 (2.5-4,306) 3 16 N/A 24/8 RFA 210 71 (37–85) 131(62.38) 18 (5–38) 9.5 (3.1–29.6) 1.0 (0.4–3.1) 12.7 (1.6–12,916) 16 122 N/A 150/60 Lee et al. 2018 TACE 31 64.8 ± 12.4 19(61.2) 21.6 ± 11.5 N/A 1.22 ± 0.66 198.97 ± 418.18 13 (41.9) 13 (41.9) 4 (12.9) 20 /11 RFA 43 64.5 ± 12.8 30 (69.7) 20.3 ± 8.8 N/A 0.91 ± 0.41 178.45 ± 479.66 26 (60.5) 18 (41.9) 2 (4.7) 28 / 15 MARTIN et al. 2019 TACE 27 66.6 ± 8.7 19 (70.4) 18 (13–27) N/A N/A 12 (4.4–34.4) N/A N/A 15 (55.6) N/A RFA 27 67.1 ± 11 15 (55.6) 20 (14–23) N/A N/A 17 (3.4–64.3) N/A N/A 12 (46.2) N/A Chu et al. 2019 TACE 314 60.5 ± 10.6 224 (77.7) 38 ± 5 N/A 1.13 ± 0.61 57 (18.2) 221 (70.4) 40 (12.7) N/A N/A RFA 115 61.1 ± 10.8 90 (78.3) 35 ± 4 N/A 1.2 ± 0.74 17 (14.8) 74 (64.3) 14 (23) N/A N/A Yun et al. 2020 TACE 268 69.3 ± 9.0 193(72.01) 28.3 ± 11.1 117 ± 50.9 N/A 181.9 ± 625.3 195 39 N/A N/A RFA 136 69.1 ± 10.1 102(75) 19.8 ± 6.9 128 ± 59.9 N/A 159.5 ± 494.4 89 20 N/A N/A Hyun Oh et al. 2020 TACE 141 62 (54.5–67) 112 (79.43) N/A 107.0 (82.0–143.0) N/A 13.1 (6.3–51.9) 98 N/A N/A N/A RFA 87 59.0 (51.0–68.0) 72(82.758) N/A 116.0 (87.0–157.0) N/A 11.8 (5.4–55.7) 67 N/A N/A N/A Kim et al. 2021 TACE 21 65 (43–84) 12(57.14) 20 ((10.0–30.0)) 138 (47–287) 0.81 (0.41–1.49) 8.23 (1.65-3,340) 15 3 2 N/A RFA 19 69 (47–76) 15(78.94) 19 (10.0–30.0) 89 (34–244) 1.0 (0.23-4.0) 14.01 (1.52-5,845) 7 5 6 N/A Tay et al. 2022 TACE 168 68 (57–75) 123(73.21) 38 (22–62) 128.0 (91.0–211.0) 0.18 [0.11–0.29] 18.0 [5.0–122.0] 78 34 11 95/71 RFA 56 65 (59–70) 43(76.78) 21 (15–27) 132.5 (82.5–171.3) 0.19 [0.12–0.38] 12.5 (7.0–58.0) 23 13 12 34/ 22 Yein Ho et al. 2022 TACE 337 67 ± 11 225(66.76) N/A 100 (71–151) 0.9[0.6–1.4] 21 [7–112] 115 140 N/A 236/101 RFA 546 67 ± 11 351(64.28) N/A 114 (86–163) 0.8 [0.5–1.2] 6 (16–65) 234 191 N/A 454/92 Data are expressed as median (range), mean ± SD or Median [IQR value]] 3.3. Quality assessment In our analysis, the quality of the articles was appraised by the Newcastle-Ottawa Scale (NOS). The NOS was a standardized instrument to appraise and rate each research quality based on specific criteria relevant to study design, methodology, and potential biases. The NOS assessment findings exposed that most of the included articles (16/18) scored ≥ 7 as good quality, in terms of study group selection, comparison of groups, and outcome assessment. The average NOS score was seven out of nine, indicating a relatively high level of methodological quality and a low risk of bias. However, a few studies have identified limitations, such as the representativeness of the exposed cohort and adequacy of follow-up of cohorts, which may have affected their NOS scores. The details of the quality assessment results for these studies can be found in Table 3 . Table 3 Methodological quality assessment of the included 18 studies, based on the NOS for assessing the quality of observational studies. Cohort studies (n = 18) Study Selection Comparability Outcome Total Score Representativeness of the exposed cohort Selection of the non-exposed cohort Ascertainment of exposure 5 Outcome was not present at start of study 6 Control for 2 important factors 2,3 Assessment of outcome Follow-up long enough Adequacy of follow-up of cohort 7 Chok et al. 2006 * * * * ** * * Good Yang Hsu et al. 2011 * * * ** * * Good Yang et al. 2014 * * * ** * * Good Kim et al. 2014 * * ** * * Fair Liu et al. 2014 * * * * ** * * Good SONG et al. 2016 * * * * ** * * Good Chen et al. 2016 * * * ** * * Good Hocquelet et al. 2016 * * * ** * * Good Lee et al. 2017 * * * * ** * * Good Ishikawa et al. 2018 * * * ** * * Good Lee et al. 2018 * * * ** * * Good MARTIN et al. 2019 * * * ** * * Good Chu et al. 2019 * * ** * * Fair Yun et al. 2020 * * * * ** * * Good Hyun Oh et al. 2020 * * * ** * * Good Kim et al. 2021 * * * ** * * * Good Tay et al. 2022 * * * ** * * Good Yein Ho et al. 2022 * * * ** * * Good 1 If the cases data was obtained from records with mentioning the process to extract information, or reference to primary record, a point was assigned. 2 If adjusted for age, a point was assigned. 3 If adjusted for drugs (e.g. anti-hypertensives, anti-diabetics etc) or any other additional factors, a point was assigned. 4 If information were obtained through national registries or hospital records, a point was assigned. 4 If information were obtained from patients and the difference in non-response rate between groups was 20% or less a point was assigned. 5 If the exposure data was obtained from prescription database or medical record, a point was assigned. 6 If the study design is prospective study, a point was assigned. 7 If the completeness of follow-up was 80% or more, a point was assigned. 3.4. Publication bias Through visualization of the funnel plot, we found a significant publication bias. 3.5. Clinical outcomes 3.5.1. Overall Survival (OS) Seventeen studies assessed the one-year overall survival (OS) rates, while seventeen and fifteen studies evaluated the three- and five-year OS rates, respectively. The pooled analysis of the one-year OS rates, as illustrated in Fig. 2 , focused on the early-stage HCC patients who underwent TACE and revealed no significant risk reduction compared to those who underwent RFA (RR = 0.97 (95% CI [0.95, 1.00]; p = 0.09). Though, the three years and five years (Supplementary Figures S1 and S 2) pooled analyses exposed a significant rise in Overall Survival favoring RFA with RR = 0.85 (95% CI [0.78, 0.92], p < 0.00001) and RR = 0.80 (95% CI [0.73, 0.89], p < 0.0001), respectively. High heterogeneity was observed (p = 0.002, I2 = 57%), (p < 0.00001, I2 = 74%), and (p = 0.0005, I2 = 63%), respectively, which could not be resolved by sensitivity analysis. Subgroup analysis We performed subgroup analysis to assess the impact of age , alpha-fetoprotein ( AFP ) levels, chemotherapy , and tumor size < 3 cm on OS; detailed findings for each subgroup are presented in ( Table 4 ) . Table 4 the results of the subgroup analysis. Analysis RR and 95%CI P-value Heterogeneity No. of studies p-value I2 Overall survival after 1 year 0.97 95% CI [0.95, 1.00] p = 0.09 p = 0.002 I2 = 57% 17 Leave one out after 1 year sub grouped by age < 60 years 1.0295% CI [0.99, 1.05] p = 0.29 p = 0.10 I2 = 41% 8 ≥ 60 years 0.93, 95% CI [0.91, 0.96] p < 0.00001 P = 0.19 I2 = 30% 8 Overall survival after 3 years 0.85 (95% CI [0.78, 0.92] p < 0.00001 p < 0.00001 I2 = 74% 17 Leave one out after 3 years sub grouped by age < 60 years 0.86, 95% CI [0.75, 0.98] p = 0.03 p = 0.002 I2 = 57% 8 ≥ 60 years 0.84, 95% CI [0.78, 0.89] p < 0.00001 p = 0.40 I2 = 3% 8 Overall survival after 5 years 0.80(95% CI [0.73, 0.89] p < 0.0001 p = 0.0005, I2 = 63% 15 Leave one out after 5 years sub grouped by age < 60 years 0.84(95% CI [0.75, 0.93] p = 0.001 p = 0.30 I2 = 18% 7 B ≥ 60 years 0.82, 95% CI [0.77, 0.87] p < 0.00001 p = 0.51 I2 = 0% 7 Overall survival after 1 year 0.97 95% CI [0.95, 1.00] p = 0.09 p = 0.002 I2 = 57% 17 Leave one out after 1 year sub grouped by alpha-fetoprotein AFP < 100 ng/mL 0.98, 95% CI [0.93, 1.04] p = 0.58 p = 0.0003 I2 = 73% 9 AFP ≥ 100 ng/mL 0.95, 95% CI [0.92,0.98] p = 0.0009 P = 0.89 I2 = 0% 5 Overall survival after 3 years 0.85 (95% CI [0.78, 0.92] p < 0.00001 p < 0.00001 I2 = 74% 17 Leave one out after 3 years sub grouped by alpha-fetoprotein AFP < 100 ng/mL 0.79, 95% CI [0.69, 0.90] p = 0.0003 p = 0.24 I2 = 25% 8 AFP ≥ 100 ng/mL 0.82, 95% CI [0.75,0.87] p < 0.0001 P = 0.42 I2 = 0% 4 Overall survival after 5 years 0.80(95% CI [0.73, 0.89] p < 0.0001 p = 0.0005, I2 = 63% 15 Leave one out after 5 years sub grouped by alpha-fetoprotein AFP < 100 ng/mL 0.79(95% CI [0.69, 0.90] p = 0.0003 p = 0.24 I2 = 25% 8 AFP ≥ 100 ng/mL 0.82, 95% CI [0.75,0.87] p < 0.0001 P = 0.42 I2 = 0% 4 Overall survival after 1 year 0.97 95% CI [0.95, 1.00] p = 0.09 p = 0.002 I2 = 57% 17 Leave one out after 1 year sub grouped by chemotherapy Adriamycin 0.94, 95% CI [0.91, 0.96] p < 0.00001 P = 0.59 I2 = 0% 5 Doxorubicin hydrochloride 1.02, 95% CI [0.95, 1.09] p = 0.65 p = 0.19 I2 = 41% 4 Overall survival after 3 years 0.85 (95% CI [0.78, 0.92] p < 0.00001 p < 0.00001 I2 = 74% 17 Leave one out after 3 years sub grouped by chemotherapy Adriamycin 0.85, 95% CI [0.80, 0.90] p < 0.00001 P = 0.43 I2 = 0% 5 Doxorubicin hydrochloride RR 0.66, 95% CI [0.58, 0.76] p < 0.00001 p = 0.62 I2 = 0% 4 Overall survival after 5 years 0.80(95% CI [0.73, 0.89] p < 0.0001 p = 0.0005, I2 = 63% 15 Leave one out after 5 years sub grouped by chemotherapy Adriamycin RR 0.81, 95% CI [0.74, 0.88] p < 0.00001 P = 0.33 I2 = 12% 4 Doxorubicin hydrochloride 0.76, 95% CI [0.42, 1.37] p = 0.36 p = 0.005 I2 = 68% 3 Overall survival after 1 year 0.97 95% CI [0.95, 1.00] p = 0.09 p = 0.002 I2 = 57% 17 Leave one out after 1 year sub grouped by tumor size < 3 cm RR 0.96, 95% CI [0.87, 1.06] p = 0.40 p = 0.10 I2 = 52% 5 Overall survival after 3 years 0.97 95% CI [0.95, 1.00] p = 0.09 p = 0.002 I2 = 57% 17 Leave one out after 3 years sub grouped by tumor size < 3 cm 0.81, 95% CI [0.67, 0.99] p = 0.03 p = 0.21 I2 = 33% 5 Overall survival after 5 years 0.97 95% CI [0.95, 1.00] p = 0.09 p = 0.002 I2 = 57% 15 Leave one out after5 years sub grouped by tumor size < 3 cm 0.81(95% CI [0.70, 0.94] p = 0.005 p = 0.41 I2 = 0% 5 In the subgroup analysis based on age , in patients aged < 60 years , no significant differences in OS at one year were observed between TACE and RFA (RR 1.02, 95% CI [0.99, 1.05], p = 0.29). The results were homogenous (P = 0.10). However, the three years and five years pooled analyses exposed a significant rise in OS favoring RFA (RR = 0.86, 95% CI [0.75, 0.98], p = 0.03) and RR = 0.84 (95% CI [0.75, 0.93], p = 0.001), respectively. High heterogeneity was noted (p < 0.0001, I2 = 77%), and (p = 0.03, I2 = 57%), respectively; sensitivity analysis could not resolve at three years but resolved at five years excluding SONG et al. 2016 (p = 0.30, I2 = 18%). In patients aged ≥ 60 years , RFA showed a significant increase in OS compared with TACE (RR = 0.93, 95% CI [0.91, 0.96], p < 0.00001) at one year, (RR = 0.84, 95% CI [0.78, 0.89], p < 0.00001) at three years, (RR = 0.82, 95% CI [0.77, 0.87], p < 0.00001) at five years. The results were homogenous at one year (P = 0.19) and five years (p = 0.51), while heterogeneity was observed at three years (p = 0.0005, I2 = 73%). The heterogeneity was resolved by sensitivity examination eliminating Hocquelet et al.2016 (p = 0.40, I2 = 3%) One-year subgroup difference test was Chi² = 16.75, df = 1 (P < 0.0001, I² = 94.0%), three-year was Chi² = 0.08, df = 1 (P = 0.78, I² = 0%), and five-year was Chi² = 0.46, df = 1 (P = 0.50, I² = 0%). In the subgroup analysis based on AFP levels , patients with an Alpha-fetoprotein ( AFP < 100 ng/mL) showed no significant differences in OS at one year between TACE and RFA (RR = 0.98, 95% CI [0.93, 1.04], p = 0.58). The results were heterogeneous (p = 0.0003, I2 = 73%) and could not be resolved by sensitivity analysis. Nonetheless, the pooled analyses for the three-year and five-year overall survival demonstrated a significant improvement in favor of radiofrequency ablation (RFA) concerning treatment outcomes. The three-year pooled analysis yielded a risk ratio (RR) of 0.79 (95% CI [0.69, 0.90], p = 0.0003), while the five-year pooled analysis occasioned an RR of 0.79 (95% CI [0.69, 0.90], p = 0.0003). Both analyses exhibited high heterogeneity (p < 0.00001, I2 = 83% for three years; p = 0.006, I2 = 64% for five years). However, through sensitivity analysis, excluding the study conducted by SONG et al. in 2016, the heterogeneity was substantially resolved, resulting in p-values of 0.24 and I2 values of 25% for both the three-year and five-year analyses, respectively. In contrast, patients with AFP ≥ 100 ng/mL showed significant differences in OS, favoring RFA (RR = 0.95, 95% CI [0.92, 0.98], p = 0.0009) at one year, (RR = 0.82, 95% CI [0.75, 0.87], p < 0.0001) at three years, and (RR = 0.82, 95% CI [0.75,0.87], p < 0.0001) at five years. The results were homogenous at one year (P = 0.89), three years (P = 0.42), and five years (P = 0.42). One-year subgroup difference test was Chi² = 1.40, df = 1 (P < 0.24, I² = 28.4%), three-year was Chi² = 0.02, df = 1 (P = 0.87, I² = 0%), and five-year was Chi² = 0.27, df = 1 (P = 0.60, I² = 0%). Furthermore, in the subgroup analysis based on chemotherapy , patients who received Adriamycin showed a significant increase in OS, favoring RFA (RR = 0.94, 95% CI [0.91, 0.96], p < 0.00001) at one year, (RR = 0.85, 95% CI [0.80, 0.90], p < 0.00001) at three years, (RR = 0.81, 95% CI [0.74, 0.88], p < 0.00001) at five years. The results were homogenous at one year (P = 0.59), three years (P = 0.43), and five years (P = 0.33). In comparison, patients who received Doxorubicin hydrochloride with TACE had no significant difference in OS at one year and five years between TACE and RFA (RR = 1.02, 95% CI [0.95, 1.09], p = 0.65) and (RR = 0.76, 95% CI [0.42, 1.37], p = 0.36), respectively. However, the three years pooled analyses exposed a significant rise in Overall Survival favoring RFA (RR = 0.66, 95% CI [0.58, 0.76], p < 0.00001). High heterogeneity was observed at one year ( p = 0.09, I2 = 53%), and three years ( p < 0.00001, I2 = 94%), resolved by sensitivity investigation rejecting MARTIN et al.2019at one year (p = 0.19, I2 = 41%) and Hocquelet et al. 2016 at three years (p = 0.62, I2 = 0%), while the heterogeneity at five years ( p = 0.005, I2 = 68%) could not be resolved by the leave-one-out test because we had three articles only in this analysis. One-year subgroup difference test was Chi² = 4.47, df = 1 (P < 0.03, I² = 77.6%), three-year was Chi² = 10.53, df = 1 (P = 0.001, I² = 90.5%), and five-year was Chi² = 0.04, df = 1 (P = 0.84, I² = 0%). In subgroup investigation related to tumor size less than 3 cm , no significant differences in OS at one year were observed between TACE and RFA (RR = 0.96, 95% CI [0.87, 1.06; p = 0.40). However, the three years and five years pooled analyses exposed a significant rise in Overall Survival favoring RFA (RR = 0.81, 95% CI [0.67, 0.99], p = 0.03) and RR = 0.81(95% CI [0.70, 0.94], p = 0.005), respectively. High heterogeneity was observed at one year (p < 0.00001, I2 = 91%), three years (p = 0.02, I2 = 65%), and five years (p = 0.03, I2 = 62%), which were resolved by sensitivity investigation eliminating Yang Hsu et al. 2011 at one year (p = 0.10, I2 = 52%), SONG et al. 2016 at three years (p = 0.21, I2 = 33%), and SONG et al. 2016 at five years (p = 0.41, I2 = 0%). 3.5.2. Progression-free survival rate (PFS) All rates of the one-, three-, and five-year progression-free survival (PFS) were assessed in a total of seven, seven, and six studies, respectively. Pooled analysis at one, three, and five years ( ( Fig. 3 ) and (Supplementary Figures S3 and S4)) established that the early-stage HCC patients who undertook TACE revealed no significant risk reduction compared to those who underwent RFA with RR = 1.48(95% CI [0.78, 2.83], p = 0.23) at one year, RR = 1.16 (95% CI [0.59, 2.26], P = 0. 67) at three years and RR = 1.21 (95% CI [0.66 to 2.23], P = 0. 54)at five years. High heterogeneity was observed (p < 0.00001, I2 = 91%), (p < 0.00001, I2 = 93%), and (p < 0.00001, I2 = 93%) respectively, which could not be resolved by using sensitivity analysis. 3.5.3. The recurrence-free survival rate (RFS) In eight studies, the 1-, 3-, and 5-year RFS rates were evaluated. Pooled analysis at one, three, and five years ( ( Fig. 4 ) and (Supplementary Figures S5 and S6)) showed that the risk reduction didn’t significantly differ between TACE and RFA among HCC patients in the early stage . The risk ratios (RR) for TACE compared to RFA were 1.12 (95% CI [0.86–1.46], p = 0.39) at one year, 0.93 (95% CI [0.64–1.37], p = 0.73) at three years, and 1.02 (95% CI [0.79–1.31], p = 0. 88) at five years. High heterogeneity was observed (p < 0.0001, I2 = 77%), (p < 0.00001, I2 = 85%), and (p < 0.0001, I2 = 77% respectively, which sensitivity analysis could not resolve. 3.5.4. Overall Survival propensity score-matching (OS-PSM) cohort Ten studies were included to evaluate the one-, three-, and five-year overall survival in patients who underwent (TACE) for early-stage (HCC). The pooled analysis of the one-year OS-PSM rates, as depicted in Fig. 5 , focused on examining the outcomes of these patients, revealed no significant risk reduction compared to those who underwent RFA with an RR of 0.99 (95% CI 0.95, 1.02], p = 0.45). However, the three years and five years (Supplementary Figures S7 and S8) , pooled analyses revealed a significant increase in Overall Survival favoring RFA with RR = 0.91 (95% CI [0.85, 0.96], p = 0.001) and RR = 0.85(95% CI [0.79, 0.92], p < 0.001), respectively. High heterogeneity was observed (p < 0.00001, I2 = 93%), (p = 0.06, I2 = 46%), and (p = 0.06, I2 = 45%), respectively, which was resolved by sensitivity investigation rejecting Chu et al. 2019 at one year (p = 0.25, I2 = 22%), Yun et al. 2020 at three years (p = 0.48, I2 = 0%), and Chu et al. 2019 at five years (p = 0.59, I2 = 0%). 3.5.5. The recurrence-free survival rate propensity-score matching (RFS-PSM) cohort Five studies were included to evaluate the one-, three-, and five-year overall survival in patients who underwent (TACE) for early-stage (HCC). The pooled analysis of the one-year RF-PSM rates, as depicted in Fig. 6 , focused on examining the outcomes of these patients, and revealed no significant risk reduction compared to those who underwent RFA with an RR of 1.22 (95% CI [0.87, 1.70], p = 0.25). Figure 6. The forest plot that demonstrates recurrence-free survival rate propensity score-matching cohort at 1 year However, the three years and five years (Supplementary Figures S9 and S10) pooled analyses revealed a significant increase in RFS-PSM favoring TACE with RR = 1.32(95% CI [1.10, 1.60], p = 0.003) and RR = 1.26(95% CI [1.10, 1.46], p = 0.001), respectively. High heterogeneity was observed (p = 0.001, I2 = 78%) at one year, which could not be resolved by sensitivity analysis (p = 0.008, I2 = 71%) at three years, and (p = 0.09, I2 = 50%) at five years resolved by sensitivity analysis eliminating Hyun Oh et al. 2020 at three years (p = 0.26, I2 = 25%) and Yun et al. 2020at five years (p = 0.32, I2 = 15%). 3.5.6. Tumor response The tumor response outcomes, including complete response (CR), partial response (PR), stable response (SR), and progressive disease (PD), were evaluated in ten studies for complete response, five studies for partial response, five studies for stable disease, and five studies for progressive disease. The findings showed that early-stage HCC patients who undertook RFA had a meaningfully greater CR rate than those who underwent TACE, with a pooled risk ratio (RR) of 0.79(95% CI, 0.68, 0.91], p = 0.0009). (Supplementary Figure S11 ) . Elevated heterogeneity was reported (p < 0.00001, I2 = 95%), which could not be resolved by sensitivity analysis. There was a significant difference in PR in favor of TACE, with a pooled RR of 5.27(95% CI [3.06, 9.06]; p < 0.00001) (Supplementary Figure S12 ) . The results were homogeneous (P = 0.84). There was also a significant difference in the SR in favor of TACE, with a pooled RR of 7.31(95% CI [2.62, 20.45], p = 0.0001) (Supplementary Figure S13 ) . The result was homogenous (P = 0.97) However, the two interventions had no significant difference in PD, with PD of 1.67 (95% CI [0.65, 4.31], p = 0.29) (Supplementary Figure S14 ) . The result was homogenous (P = 0.44) 3.5.7 Adverse effects The analysis of adverse event rates did not reveal a significant reduction in risk between transarterial chemoembolization (TACE) and radiofrequency ablation (RFA), with a risk ratio (RR) of 1.01 (95% CI [0.41, 2.53], p = 0.98). However, it is important to note that high heterogeneity was observed (p = 0.08, I2 = 47%), which was subsequently resolved through sensitivity analysis by excluding the study conducted by Chu et al. in 2019 (p = 0.19, I2 = 33%). Furthermore, the analysis of total deaths also indicated no significant risk reduction between TACE and RFA, with an RR of 1.13 (95% CI [0.97, 1.30], p = 0.11). These findings are illustrated in Figs. 7 and 8 . The studies included in the analysis assessed the outcome of death due to liver failure in patients who underwent either (TACE) or (RFA). In the TACE group, 1–2 patients died from liver failure, however, in the RFA group, 1–16 patients experienced the same outcome, and 1–3 patients experienced a pneumothorax. Discussion Our review proposed to compare the effectiveness of each TACE and RFA treatment for HCC. In this meta-analysis, after comparing TACE with RFA, we found that RFA had better 3-year and 5-year overall survival (OS). Additionally, there was no significant difference in one year except, in patients aged ≥ 60 years , those with AFP ≥ 100 ng/ml or who received Adriamycin , RFA had better 1-year OS. Also, RFA had better 3- and 5-year overall survival propensity score-matching (OS-PSM). There was a significant difference between age and chemotherapy groups at one-year (P < 0.0001, I² = 94.0%), and (P < 0.03, I² = 77.6%) respectively. Also, chemotherapy subgroups significantly differed at three-year (P = 0.001, I² = 90.5%). However, there was no significant difference between TACE and RFA in the recurrence-free survival rate (RFS) or the progression-free survival rate (PFS). In contrast, 3- and 5-year pooled analyses revealed a significant increase in the recurrence-free survival rate propensity-score matching ( RFS-PSM ) cohort regarding TACE with RR = 1.32(95% CI [1.10, 1.60], p = 0.003) and RR = 1.26(95% CI [1.10, 1.46], p = 0.001), respectively. In contradiction of another meta-analysis, Gui et al. ( 21 ) demonstrated that resection (SR) had superior 3- and 5-year disease-free survival (DFS) compared to a combination of TACE and RFA, without any significant impact on overall survival. Similarly, in a different meta-analysis conducted by Wang et al. ( 22 ), the TACE and RFA combination exhibited improved 1-year overall survival (OS) (OR = 1.88, p = 0.02) compared to resection (SR), without significant difference in 3- and 5-year DFS. Regarding the tumor response outcomes, RFA had a meaningfully greater complete response ( CR ) rate than those who underwent TACE, with a pooled risk ratio (RR) of 0.79(95% CI, 0.68, 0.91], p = 0.0009). Though, partial response ( PR ) and stable response ( SR ) significantly differ regarding TACE , with a pooled RR of 5.27(95% CI [3.06, 9.06]; p < 0.00001) and RR of 7.31(95% CI [2.62, 20.45], p = 0.0001), respectively. These findings have significant implications for the management of HCC and contribute to redefining the TACE role. In the past, TACE has often been used as a comforting HCC therapy. However, it is important to note that TACE does not solely provide palliation for tumor-related symptoms ( 23 ). Studies have demonstrated that the combination of TACE and RFA yields comparable overall survival (OS) and disease-free survival (DFS) outcomes in recurrent HCC patients ( 24 ). Additionally, TACE as a standalone therapy has been stated to recover survival consequences in intractable HCC ( 25 ). These findings underline the potential benefits and effectiveness of TACE in the management of HCC beyond its palliative perception. Although the adverse event rate and mortality rate didn’t significantly differ in TACE than in RFA, patients died from liver failure in the TACE group lower than in the RFA group. In addition, there were 1–3 patients who experienced a pneumothorax in the RFA group. However, the two interventions had no significant difference in progressive disease (PD). In Gui et al. ( 21 ) meta-analysis, Surgical resection (SR) was linked to an extended duration of hospitalization and a higher occurrence of significant problems compared to the combination of TACE and RFA. The articles in this meta-analysis didn’t report the quality of life (QoL). Earlier investigations focusing on TACE have indicated that various factors influence QoL experienced by patients. These factors include patient-related aspects such as psychosocial support, disease-related aspects like hepatic dysfunction, illness progress, and problems, as well as therapy-related aspects including adverse events and lengthy hospital stays ( 26 ). Although the present study showed RFS has better OS than TACE, TACE showed safety evidence over RFS. In contrast, there were some disadvantages of TACE including; a higher local tumor recurrence rate compared to LR or RFA ( 27 ), an increased liver failure risk in cases with Child-Pugh B or C cirrhosis ( 28 ), the potential for portal vein thrombosis ( 29 ), and the occurrence of post-embolization syndrome ( 30 ). Our study defined that TACE as a monotherapy doesn’t be the drug of choice for early-stage HCC. Some alternatives showed better effects, including; MWA, PEI, and HIFU. Initially, Microwave ablation (MWA) operates by inducing thermal energy through the agitation of water molecules and the generation of friction. It possesses certain advantages over radiofrequency ablation (RFA) such as a diminished heat sink effect and a shorter treatment duration ( 31 ). However, it exhibits diminished effectiveness in tumors larger than 5 cm ( 32 ), and the treatment outcomes may differ depending on the specific devices used ( 33 ). The combination of MWA and RFA with TACE therapy has demonstrated enhanced local tumor control through multiple mechanisms. The incorporation of TACE alongside RFA is anticipated to decrease localized tumor progress by rejecting blood flow. Moreover, TACE can minimize thermal harm during the ablation process, thereby expanding the ablative region and enhancing the handling of potential micro-metastases surrounding the primary tumor ( 34 ). In a prior study involving metastatic cases, RFA and TACE combination exhibited a local recurrence rate similar to that of resection (LR). However, when analyzing a single randomized controlled trial (RCT), RFA plus TACE demonstrated inferior overall survival (OS) and recurrence-free survival (RFS) compared to LR. Nevertheless, when examining non-randomized trials (NRTs), the outcomes between the two treatment groups were comparable ( 34 ). Microwave ablation (MWA) yielded comparable OS and RFS results to the LR group, although it displayed a higher incidence of local recurrence compared to LR. Additionally, MWA did not address the limitations of RFA, including its high local recurrence rate and suboptimal RFS ( 34 ). The superiority of MWA compared to Liver Resection (LR) in terms of oncologic efficacy remains uncertain, as indicated by an analysis of several cohort studies ( 35 ). Furthermore, there is insufficient evidence to establish whether MWA outperforms RFA using RFS and OS ( 36 , 37 ). A new study demonstrated that patients with microvascular invasion who underwent RFA had a higher risk of recurrence compared to those who underwent LR ( 38 ). Hence, in microvascular invasion risk patients, characterized by elevated serum tumor markers and prominent arterial peritumoral improvement ( 38 ), localized ablation treatment may not be the most suitable therapeutic option. This potential may contribute to the lower oncologic outcomes observed with RFA, RFA plus TACE, or MWA compared to LR. Second, Percutaneous ethanol injection (PEI) is a method of injecting ethanol into the tumor, resulting in coagulation necrosis. It exhibits the highest effectiveness in HCC cases that are smaller than 2 cm. PEI is a moderately priced, straightforward technique that holds appeal for regions with limited resources. It is also feasible in patients with cirrhosis and generally well-tolerated ( 39 , 40 ). However, PEI does have certain drawbacks. One limitation is the non-uniform distribution of ethanol within the tumor, particularly when septa are present ( 40 ). Additionally, PEI is associated with higher rates of recurrence and inferior overall survival compared to ablative techniques ( 41 ). It requires multiple injections and is considered an outdated approach in some cases ( 31 ). Finally, High-intensity focused ultrasound (HIFU) is an ultrasound-based technique that exerts both thermal effects, resulting from energy absorption, and non-thermal effects such as cavitation and boiling bubbles ( 42 ). Currently, HIFU is primarily investigated as an experimental approach for patients with Child-Pugh cirrhosis as a bridge to liver transplantation ( 43 ). This modality offers selectivity and non-invasiveness, making it feasible to perform ablation near large blood vessels. Combining HIFU with TACE may prove to be a more active therapeutic choice for HCC cases measuring less than 5 cm than TACE alone ( 44 ). However, it is important to note that HIFU has limitations, including limited therapeutic windows between the ribs, which can result in reflection and unintended burns. Additionally, the treatment is significantly affected by respiratory motion, often requiring mechanical ventilation to mitigate disruptions ( 42 ). One notable strength of this meta-analysis is its unique distinction as the inaugural study of its type to incorporate propensity-matched articles subgroup analysis. Additionally, our analysis is superior to conducting a more detailed stratification of the recurrence of the tumor response outcomes, including (CR), (PR), (SR), and (PD). Furthermore, it is the first to analyze one tumor size < 3cm. Regarding our analysis limitations, the predominance of retrospective articles introduces a heightened potential for bias, particularly in terms of patient selection. Additionally, therapeutic options are significantly affected by the availability of limited resources and expertise levels, which may limit the generalizability of the findings. Moreover, there was heterogeneity in most of the outcomes which was mainly affected by factors such as; age and previously taken chemotherapy. Then, we found publication bias in many studies. Finally, this study did not compare the hospital stay or the quality of life. Conclusion In summary, the oncological outcomes of transarterial chemoembolization (TACE) were not superior to those of radiofrequency ablation (RFA) in patients who suffered hepatocellular carcinoma (HCC). These findings were affected by the heterogeneity which was mainly affected by factors such as; age and previously taken chemotherapy. However, TACE did provide the advantage of decreased morbidity and adverse effects. To reassess the position of TACE as a potentially curative option compared to RFA, additional well-designed multicenter randomized studies of high quality are necessary. Abbreviations Hepatocellular Carcinoma (HCC) Trans arterial chemoembolization (TACE) Radiofrequency ablation (RFA) Progression-free survival (PFS) Tumor response (TR) Adverse event rate (AER). Hepatitis B virus (HBV) Hepatitis C virus (HCV) The preferred reporting items for systematic reviews and meta‐analyses (PRISMA) Randomized controlled trials (RCTs) Newcastle-Ottawa Scale (NOS) Propensity-score matching (PSM) Risk ratio (RR) Mean difference (MD) Complete response (CR) Partial response ( PR ) Stable response ( SR ) Progressive disease (PD) Disease-free survival (DFS) Microwave ablation (MWA) Declarations Conflicts of interest: Mahmoud Shaban Abdelgalil has nothing to disclose. All the authors also declare no conflict of interest. Funding: All author(s) received no financial support for the research, authorship, and/or publication of this article. Ethics approval: not applicable Consent to participate: not applicable Consent for publication: not applicable Availability of data and material: All data generated or analyzed during this study are included in this published article or in the data repositories listed in References. Code availability: not applicable Acknowledgement: I dedicate this study to my parents and my sister for their endless love and support. I hope this achievement will fulfill the dreams they envisioned for me. Authors’ Contributions: Mahmoud Shaban Abdelgalil led the team, carried out the search strategy and data collection steps, resolved any conflicts during the screening phase, and resolved any conflicts during the quality evaluation phase, and did the analysis. Bahaa Elfakharany took part in the title and abstract screening, the full-text screening, data extraction and wrote the introduction. Mohamed El-Samahy took part in the quality assessment, data extraction, and wrote the result section. Ibraheem M alkhawaldeh took part in the full-text screening, data extraction, and drafted the tables. Neveen Refaey contributed to the quality evaluation phase and wrote the method section. Saad Ashraf ALsaad was involved in the title and abstract screening, quality assessment, and data extraction. Dina Alaraby wrote the discussion section, the abstract and edited the manuscript. References Llovet JM, Singal AG, Villanueva A, et al. Prognostic and predictive factors in patients with advanced HCC and elevated alpha-fetoprotein treated with ramucirumab in two randomized phase III trials. Clin Cancer Res. 2022;28:2297–305. Rumgay H, Arnold M, Ferlay J, Lesi O, et al. Global burden of primary liver cancer in 2020 and predictions to 2040. J Hepatol. 2022;77:1598–606. McGlynn KA, Petrick JL, London WT. Global epidemiology of hepatocellular carcinoma: an emphasis on demographic and regional variability. Clin Liver Dis. 2015;19:223–38. Rahib L, Smith BD, Aizenberg R et al. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74:2913–21. Galle PR, Forner A, Llovet JM, et al. 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Kamal A, Abd Elmoety AA, Rostom YAM, et al. Percutaneous radiofrequency versus microwave ablation for management of hepatocellular carcinoma: a randomized controlled trial. J Gastrointest Oncol. 2019;10:562. Lee S, Kang TW, Song KD, et al. Effect of microvascular invasion risk on early recurrence of hepatocellular carcinoma after surgery and radiofrequency ablation. Ann Surg. 2021;273:564–71. Ahmed M, Brace CL, Lee Jr FT, et al. Principles of and advances in percutaneous ablation. Radiology. 2011;258:351–69. Daher S, Massarwa M, Benson AA, et al. Current and future treatment of hepatocellular carcinoma: an updated comprehensive review. J Clin Transl Hepatol. 2018;6:69. Majumdar A, Roccarina D, Thorburn D, et al. Management of people with early‐or very early‐stage hepatocellular carcinoma. Cochrane Database Syst Rev. 2017. Maloney E, Hwang JH. Emerging HIFU applications in cancer therapy. Int J Hyperth. 2015;31:302–9. Chok KSH, Cheung TT, Lo RCL, et al. Pilot study of high‐intensity focused ultrasound ablation as a bridging therapy for hepatocellular carcinoma patients wait‐listed for liver transplantation. Liver Transplant. 2014;20:912–21. Kim J, Chung DJ, Jung SE, et al. Therapeutic effect of high-intensity focused ultrasound combined with transarterial chemoembolisation for hepatocellular carcinoma< 5 cm: comparison with transarterial chemoembolisation monotherapy—preliminary observations. Br J Radiol. 2012;85(1018):e940–6. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFigs.S1.docx SupplementaryFigs.S2.docx SupplementaryFigs.S3.docx SupplementaryFigs.S4.docx SupplementaryFigs.S5.docx SupplementaryFigs.S6.docx SupplementaryFigs.S7.docx SupplementaryFigs.S8.docx SupplementaryFigs.S9.docx SupplementaryFigs.S10.docx SupplementaryFigs.S11.docx SupplementaryFigs.S12.docx SupplementaryFigs.S13.docx SupplementaryFigs.S14.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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18:10:56","extension":"docx","order_by":12,"title":"","display":"","copyAsset":false,"role":"supplement","size":22796,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigs.S12.docx","url":"https://assets-eu.researchsquare.com/files/rs-3372637/v1/04707850a0e9981f3c775372.docx"},{"id":44381228,"identity":"92ff7009-8966-49fc-9734-c11949f1822d","added_by":"auto","created_at":"2023-10-10 18:26:56","extension":"docx","order_by":13,"title":"","display":"","copyAsset":false,"role":"supplement","size":22313,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigs.S13.docx","url":"https://assets-eu.researchsquare.com/files/rs-3372637/v1/4d1949068fe49d7a76e15466.docx"},{"id":44380485,"identity":"b298c83e-ff29-4903-afa3-93baaa25eb0f","added_by":"auto","created_at":"2023-10-10 18:18:56","extension":"docx","order_by":14,"title":"","display":"","copyAsset":false,"role":"supplement","size":22499,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigs.S14.docx","url":"https://assets-eu.researchsquare.com/files/rs-3372637/v1/d31989d68384d692ea551e5c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unraveling the Controversy: Transarterial Chemoembolization versus Radiofrequency Ablation in Early Hepatocellular Carcinoma - A Systematic Review and Meta-Analysis","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eLiver cancer remains a pressing concern for global health, with more than 1\u0026nbsp;million cases anticipated by 2025 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Globally, liver cancer ranks as the sixth most prevalent cancer, with 905,700 new cases reported in 2020 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), and is the fourth leading cause of cancer-related mortality worldwide (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Approximately 90% of liver cancer cases are attributed to hepatocellular carcinoma (HCC) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHCC has the highest prevalence and mortality rates in East Asia and Africa, with rising incidence and mortality observed in various regions of Europe and the USA (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Since the early 2000s, HCC has been the fastest-growing cause of US cancer-related deaths, as reported by the Surveillance Epidemiology End Results. If these trends persist, it may become the third leading cause of cancer mortality by 2030 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHCC is closely linked to chronic liver disease, particularly cirrhosis, which is responsible for more than 90% of HCC cases. Several notable predictors of HCC development, containing chronic alcohol consumption, diabetes, nonalcoholic steatohepatitis (NASH) associated with obesity, as well as infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). Additionally, although less common, HCC can also arise from cirrhosis caused by primary biliary cholangitis, hemochromatosis, or α1-antitrypsin deficiency (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe optimal treatment choices for HCC are liver transplantation or resection. However, Non-surgical treatment options are commonly utilized in real-world practice for patients with HCC, often due to tumor burden, hepatic functional reserves, organ donor availability, surgical risks, and patient preferences. The recommended HCC nonsurgical options in these situations include radiofrequency ablation (RFA) and Trans arterial chemoembolization (TACE) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRFA employs a catheter tip to deliver a high-frequency alternating current, resulting in tissue necrosis within a 1.5 cm radius induced by thermal energy. RFA is considered the primary treatment option for individuals with very early-stage HCC, defined as a single tumor with a diameter smaller than 2 cm. It is also recommended as an early-stage HCC substitute treatment, which includes a single tumor sized 5 cm or 3 nodules sized\u0026thinsp;\u0026lt;\u0026thinsp;3 cm.\u003c/p\u003e \u003cp\u003eRFA is favored in these cases due to its less invasive nature and better tolerability when compared to hepatic resection (\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, RFA has high post-procedural recurrence rates, reaching 70% at 5 years, impacting the long-term survival of these patients (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In addition, RFA may not be feasible in cases where tumors are located in specific liver regions or close to the diaphragm, bowel lumen, or bile duct, as it increases bleeding, perforation, or bile leakage as complications (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In situations where resection and transplantation of the liver aren\u0026rsquo;t possible choices, TACE may be a feasible substitute (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTACE induces tumor ischemia and facilitates the local delivery of chemotherapeutic agents through the hepatic artery via the infusion of chemotherapy agents. Although retrospective cohort studies have provided evidence of satisfactory survival outcomes for na\u0026iuml;ve patients treatment who diagnosed with early-stage HCC, TACE is predominantly enhanced as a comforting therapeutic method for HCC patients in intermediate-to-advanced stage (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMultiple studies have compared TACE and RFA in patients with HCC, using the Milan criteria (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). According to a study conducted by Hsu et al. in 2011, comparable overall survival rates were observed between TACE and RFA. However, RFA demonstrated superior outcomes specifically for small tumors with a total tumor volume of less than 11 cm3. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThough, additional articles have detected comparable overall survival and tumor response/recurrence rates between TACE and RFA in small tumors (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In contrast, guidelines recommend RFA for early HCCs\u0026thinsp;\u0026lt;\u0026thinsp;3 cm and TACE for intermediate ones.Real-world factors involving patients and tumors often hinder strict compliance with these guidelines (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWith the contradictory findings in the literature regarding TACE in tumors small sized and the existing medical practice guiding principle advocating for \u0026lt;\u0026thinsp;3 cm sized HCCs ablation, there is a need to carefully consider the best treatment approach, so we aimed to conduct this systematic review and meta-analysis to compare the safety and efficacy of TACE as a substitute to RFA for HCC patients in early-stage.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eIn conducting our study and presenting our findings, we followed the prescribed writing rules for systematic reviews and meta-analyses, namely the PRISMA 2020 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and Cochrane Handbook of Systematic Reviews of Intervention (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Additionally, we registered our meta-analysis protocol in PROSPERO under the identifier \"CRD42023414662.\"\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Literature search\u003c/h2\u003e \u003cp\u003eWe used Cochrane Library, PubMed, Web of Science, and Scopus databases for searching the literature, with a search period from inception to January 31, 2023. The detailed search strategy and terms related to \u0026ldquo;trans-arterial chemoembolization\u0026rdquo;, \u0026ldquo;radiofrequency ablation\u0026rdquo;, and \u0026ldquo;hepatocellular carcinoma (HCC)\u0026rdquo; are provided in \u003cb\u003eSupplementary File S1\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Eligibility Criteria and Study Selection\u003c/h2\u003e \u003cp\u003eTwo authors, S A, and B E, assessed articles to determine whether they met the inclusion criteria. Their evaluation focused on randomized controlled trials (RCTs), non-randomized comparative studies, and observational studies (prospective and retrospective cohort studies) that investigated the clinical efficacy and safety of TACE in comparison with RFA in participants diagnosed with early HCC, which is defined as a solitary nodule\u0026thinsp;\u0026lt;\u0026thinsp;5 cm or three nodules\u0026thinsp;\u0026le;\u0026thinsp;3 cm in size, deprived of extrahepatic spread or vascular invasion. Additionally, a third author served as an arbitrator to resolve discrepancies between the original authors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Exclusion criteria\u003c/h2\u003e \u003cp\u003eThe following studies were excluded; 1) Studies with larger tumor sizes or with other HCC stages were excluded. 2) Other study designs, such as cross-sectional studies, case series, case reports, editorials, and non-human studies because of increased publication bias risk. We also excluded conference abstracts. 2) Different treatment modalities such as surgery or percutaneous ethanol injection. 3) Studies did not compare TACE and RFA as primary interventions. 4) Studies were not published in English. Or 5) Studies had unreliable extracted data for investigation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Quality assessment\u003c/h2\u003e \u003cp\u003eThe assessment of the quality of the involved cohort studies was conducted using the Newcastle-Ottawa Scale (NOS) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The NOS comprises three domains, namely selection, comparability, and outcomes. A total score of 9 can be achieved on the NOS. A NOS score of 7 or higher was deemed indicative of high quality. Two independent authors rated the quality separately and resolved discrepancies through discussion, or with a third reviewer as an arbitrator.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Data Extraction and Study Outcomes\u003c/h2\u003e \u003cp\u003eFour authors independently performed data extraction using a standardized methodology. In cases of disagreement, the discrepancies were resolved through discussion or by consulting the senior author. The initial screening of studies for potential inclusion was based on the title and abstract, followed by a thorough full-text review of included studies. Relevant data were extracted from each study into a predefined Excel spreadsheet. A concise overview of the prominent characteristics of the studies, descriptions of the patients who were enrolled, and the outcomes of TACE and RFA in terms of safety and efficacy, were extracted. Data extraction was conducted either through in-text descriptions or by visual estimation from Kaplan-Meier survival curves at specific time points (1-, 3- and 5-year).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Outcome definition\u003c/h2\u003e \u003cp\u003eThis study assessed treatment efficacy based on multiple outcomes, including overall survival (OS) (defined as the time from treatment initiation to death or last follow-up), recurrence-free survival rate (RFS) (patients proportion without hepatocellular carcinoma recurrence), progression-free survival (PFS) (patients proportion without disease progression), tumor response (TR) (patients proportion through a whole, fractional, constant, or advanced response), and adverse event rate (AER) (patients proportion with treatment-related adverse events). Propensity-score matching (PSM) cohort analysis detected rates of overall survival and recurrence-free survival, representing the proportions of patients alive after therapy initiation and those remaining free of HCC recurrence, respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.7. Data Synthesis and Heterogeneity Assessment\u003c/h2\u003e \u003cp\u003eRevman software Version 5.4.1 was employed to conduct all statistical analyses. The combined risk ratio (RR) was computed for dichotomous data, while the continuous one was expressed by the mean difference (MD) as well as confidence intervals (CI 95%) for both. To ascertain statistical significance and heterogeneity, a p-value was used. It was less than 0.05 and 0.10 indicating significance and heterogeneity, respectively. If heterogeneity was found, a random-effects model was used, and a leave-one-out test was performed to determine which study was responsible for heterogeneity. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Literature search results\u003c/h2\u003e \u003cp\u003eA comprehensive search across various databases, such as PubMed, Web of Science, Cochrane Library, and Scopus, yielded a total of 2543 studies. Among them, 711 duplicates were identified and subsequently removed. Through a thorough assessment of titles and abstracts, 1817 publications were omitted because they didn’t fulfill our study inclusion criteria. Following this initial screening, 20 full-text researchers were carefully assessed to determine their suitability. Ultimately, about 18 studies were comprised of our meta-analysis, as depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Summary of the included studies\u003c/h2\u003e \u003cp\u003eThe meta-analysis included 4537 patients, with 2449 patients receiving TACE and 2088 patients receiving RFA. The age range of the patients in this study was 57–71 years. The studies were conducted in various settings and geographical locations, offering a diverse range of evidence for meta-analysis. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents a comprehensive summary of the trials that were included in this study, offering a detailed overview of their key aspects. On the other hand, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides insightful information regarding the baseline characteristics of the patients involved in these trials.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ecomprehensive overview of the included studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy ID\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy design, country, study duration\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSample size of each group\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCriteria\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eType of TACE\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTace dose\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eConclusion\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChok et al. 2006\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort,\u003c/p\u003e \u003cp\u003eHong Kong,\u003c/p\u003e \u003cp\u003e(2001–2004).\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 268),\u003c/p\u003e \u003cp\u003eRFA (n = 136)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Age ≥ 19 years\u003c/p\u003e \u003cp\u003e• Presence of measurable lesion according to mRECIST\u003c/p\u003e \u003cp\u003e• Single tumors sized up to 5 cm or up to three nodules measuring ≤ 3 cm\u003c/p\u003e \u003cp\u003e• ECOG performance status 0–2,\u003c/p\u003e \u003cp\u003e• Platelet count ≥ 50×103/µL\u003c/p\u003e \u003cp\u003e• Serum alanine aminotransferase levels (ALT) \u0026lt; 10 times the upper limit of normal.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdriamycin 30 mg − 50 mg\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRFA and TACE were equally effective in treating patients with unresectable hepatocellular carcinoma (HCC) in terms of survival outcomes.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYang Hsu et al. 2011\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort PSM,\u003c/p\u003e \u003cp\u003eTaiwan,\u003c/p\u003e \u003cp\u003e(2002–2010)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 215), RFA (n = 315)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Caudate HCC within the Milan criteria.\u003c/p\u003e \u003cp\u003e• Milan criteria included one lesion ≤ 5 cm or 2–3 lesions ≤ 3 cm each without vascular invasion or extrahepatic spread.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdriamycin\u003c/p\u003e \u003cp\u003e20 to 30 mg of\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePatients with a smaller TTV (\u0026lt; 11 cm3) are likely to benefit more from RFA treatment.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYang et al. 2014\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort,\u003c/p\u003e \u003cp\u003eKorea,\u003c/p\u003e \u003cp\u003e(2005–2013)\u003c/p\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 66), RFA (n = 79)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Single-nodule HCC was smaller than or equal to 3 cm without vascular invasion.\u003c/p\u003e \u003cp\u003e• Who were treated initially with HR, RFA, or TACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDoxorubicin hydrochloride mitomycin\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTACE is effective in achieving comparable long-term survival rates to HR and RFA for small single-nodule hepatocellular carcinoma.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKim et al. 2014\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort,\u003c/p\u003e \u003cp\u003eSouth Korea,\u003c/p\u003e \u003cp\u003e(2005–2015)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 122), RFA (n = 165)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Single HCC with the largest diameter of 2 cm or less, no vascular invasion, and no extrahepatic disease were initially treated with TACE or RFA.\u003c/p\u003e \u003cp\u003e• Patients refusing surgery due to age, finances, or preference and those ineligible for surgery due to hepatic function or comorbidities were included.\u003c/p\u003e \u003cp\u003e• Patients with unpredictable transplantation times during the liver transplantation waiting period were also included.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.5 Cisplatin mg / ml in distilled water at a dose of 2 mg / kg of patient\u003c/p\u003e \u003cp\u003eweight (4 ml / kg).\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTACE may be a viable alternative treatment for ≤ 2 cm HCCs when RFA is not feasible.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiu et al. 2014\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort PSM, Taiwan,\u003c/p\u003e \u003cp\u003e(2002–2013).\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 282)\u003c/p\u003e \u003cp\u003eRFA (n = 424)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Patients within the Milan criteria who received RFA or TACE as their primary\u003c/p\u003e \u003cp\u003etreatment\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdriamycin 20–30 mg\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFor HCC patients within the Milan criteria with a performance status of 0, RFA provides better long-term survival than TACE.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSONG et al. 2016\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort, Korea\u003c/p\u003e \u003cp\u003e(2004–2010)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 71), RFA (n = 43)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Single HCC ≤ 5 cm or up to three HCCs ≤ 3 cm,\u003c/p\u003e \u003cp\u003e• At least two HCC lesions of a minimum of 10 mm in diameter based on liver dynamic CT with target lesions suitable for accurate repeated measurements,\u003c/p\u003e \u003cp\u003e• ECOG performance status of 0 or 1,\u003c/p\u003e \u003cp\u003e• Preserved liver function (Child-Pugh Class A or B),\u003c/p\u003e \u003cp\u003e• No previous treatment for HCC\u003c/p\u003e \u003cp\u003e• No vascular invasion\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eselective TACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDoxorubicin hydrochloride 50 mg/m2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTACE + RFA combination treatment has favorable local recurrence and improved overall survival rates in early-stage HCC patients, especially for tumors \u0026lt; 3 cm..\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChen et al. 2016\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort PSM, China, (2007–2011)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 311)), RFA (n = 338)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Confirmed diagnosis of HCC (by biopsy or clinical criteria)\u003c/p\u003e \u003cp\u003e• BCLC stage 0/A HCC (single tumor \u0026lt; 5 cm or up to three tumors ≤ 3 cm)\u003c/p\u003e \u003cp\u003e• initial treatment with TACE or RFA, TACE is considered an alternative treatment for unsuitable cases\u003c/p\u003e \u003cp\u003e• Eastern Cooperative Oncology Group performance status of 0–1\u003c/p\u003e \u003cp\u003e• Child-Pugh liver function score of A/B.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5-fluorouracil 1.0 g\u003c/p\u003e \u003cp\u003eOxaplatin 150 mg, Mitomycin C 10 mg\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTrans-arterial chemoembolization is an effective alternative treatment for unresectable BCLC stage 0/A HCC when RFA is not feasible.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHocquelet et al. 2016\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort, France, (2004–2013)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 61), RFA (n = 61)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Consecutive cirrhotic patients with single HCC ≤ 5 cm or up to three nodules ≤ 3 cm are unsuitable for surgery without extrahepatic metastasis.\u003c/p\u003e \u003cp\u003e• Based on local tumor board decisions, patients were treated with first-line RFA or supra-selective Tace.\u003c/p\u003e \u003cp\u003e• Child-Pugh A liver function and no other cancer.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eselective TACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003edoxorubicin hydrochloride (50mg in 10 ml)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFor Child-Pugh A patients with early-stage HCC, using supra-selective TACE instead of RFA, which is challenging with common US guidance, leads to decreased local tumor control and overall survival\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLee et al. 2017\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort, Korea, (2008–2013)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 150), RFA (n = 36)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• HCC patients with BCLC stages 0, B, C, D,\u003c/p\u003e \u003cp\u003e• undetermined BCLC stage, multiple (≥ 2) tumor\u003c/p\u003e \u003cp\u003e• tumor size of 3 cm or \u0026gt; 5 cm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRFA has better OS and PFS rates than TACE, respectively, but similar OS and PFS rates compared with SR, respectively, for single 3 to 5 cm sized HCC with BCLC stage A.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIshikawa et al. 2018\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort PSM, Japan\u003c/p\u003e \u003cp\u003e(2009–2014)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 32), RFA (n = 210)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• HCC patients who diagnosed regarding the American Association for the Study of Liver Diseases criteria. patients in BCLC stage 0/A within the Milan criteria.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emiriplatin 120 mg\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTACE can substitute RFA at least in some patients with BCLC 0/A HCC.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLee et al. 2018\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort, Taiwan, (2005–2016)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 31), RFA (n = 43)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Caudate HCC within the Milan criteria (one lesion ≤ 5 cm or 2–3 lesions ≤ 3 cm each without vascular invasion or extrahepatic spread).\u003c/p\u003e \u003cp\u003e• All the patients in this study had only one HCC in the caudate lobe.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003edoxorubicin hydrochloride 10–40 mg\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRFA appears to outperform TACE for patients with caudate HCC within the Milan criteria and should be the favored treatment option when surgical resection is not feasible.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMARTIN et al. 2019\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort, USA, (2005–2014)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 27)\u003c/p\u003e \u003cp\u003eRFA (n = 27)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Adult patients ≥ 18 years diagnosed with solitary HCC ≤ 3 cm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eselective TACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDoxorubicin\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRFA has better OS and PFS rates than TACE, respectively, but similar OS and PFS rates compared with SR, respectively, for single 3 to 5 cm sized HCC with BCLC stage A.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChu et al. 2019\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort PSM, South Korea,\u003c/p\u003e \u003cp\u003e(2000–2016)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 314), RFA (n = 115)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Single medium-sized (3.1–5-cm) HCC.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ecisplatin 2 mg/kg body weight\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eChemoembolization plus RF ablation may provide better survival outcomes than chemoembolization or RF ablation monotherapy, and can be considered a viable alternative treatment for unresectable single medium-sized HCCs.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYun et al. 2020\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort, Korea\u003c/p\u003e \u003cp\u003e(2005–2016)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 268), RFA (n = 136)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Age ≥ 19 years\u003c/p\u003e \u003cp\u003e• Presence of measurable lesion according to mRECIST\u003c/p\u003e \u003cp\u003e• Single tumor ≤ 5 cm or up to three nodules ≤ 3 cm,\u003c/p\u003e \u003cp\u003e• ECOG performance status 0–2\u003c/p\u003e \u003cp\u003e• platelet count ≥ 50×103/µL\u003c/p\u003e \u003cp\u003e• ALT levels \u0026lt; 10x upper limit of normal\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdriamycin (50 mg-30 mg)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTACE could be an effective alternative to RFA in terms of the 5-year OS rate for early-stage HCC. However, TACE should be confined only to RFA-difficult cases, given its lower CR and RFS rates and risk of deterioration in the liver function after treatment, as compared with RFA\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyun Oh et al. 2020\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort, Korea\u003c/p\u003e \u003cp\u003e, (2009–2013)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRFA (n = 87), TACE (n = 141)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Milan criteria defined by 2–3 nodules and tumor size ≤ 3 cm without vascular invasion, bile duct invasion, or extrahepatic metastasis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eChemoembolization plus RF ablation may provide better survival outcomes than chemoembolization or RF ablation monotherapy, and can be considered a viable alternative treatment for unresectable single medium-sized HCCs.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKim et al. 2021\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epilot non-randomized trial, Korea,\u003c/p\u003e \u003cp\u003e(2010–2017)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 21)\u003c/p\u003e \u003cp\u003eRFA (n = 19)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Treatment-naïve HCC,\u003c/p\u003e \u003cp\u003e• Child-Pugh class A or B,\u003c/p\u003e \u003cp\u003e• ECOG performance status 0–2,\u003c/p\u003e \u003cp\u003e• absence of main portal vein thrombosis and extrahepatic metastases,\u003c/p\u003e \u003cp\u003e• high risk for surgery or refusal of surgery despite clinician's advice.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDEB-TACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003edoxorubicin (50 or 75 mg)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDEB-TACE or RFA were similar. DEB-TACE could be applied selectively in patients with a single small HCC if the other therapeutic modality is unfeasible.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTay et al. 2022\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort, Singapore, (2010–2014)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 168), RFA (n = 56)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• Patients treated with either TACE or RFA as the first line monotherapy for Barcelona Clinic Liver Cancer (BCLC) stage 0, A or B HCC\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCisplatin, Doxorubicin or Adriamycin.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePatients with early-stage HCC, both TACE and RFA led to similar overall survival and recurrence rates. This suggest that TACE may be considered as an alternative treatment option in patients unsuitable for surgery and/or RFA.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYein Ho et al. 2022\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort, Taiwan,\u003c/p\u003e \u003cp\u003e(2002–2017)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE (n = 337)\u003c/p\u003e \u003cp\u003eRFA (n = 546),\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e• HCC with single tumor up to 5 cm or two to three nodules less than 3 cm, without vascular invasion or extrahepatic metastasis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdriamycin 20–30 mg\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTBS is a feasible prognostic predictor in HCC patients within the Milan criteria. TACE may be an effective treatment alternative for these patients. Among patients with low TBS, RFA should be considered the priority treatment modality.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eAbbreviations: HCC (hepatocellular carcinoma) BCLC ( Barcelona Clinic Liver Cancer staging system) TBS (tumor burden score) TTV (total tumor volume) RFA (radiofrequency ablation) SR (surgical resection) TACE (trans-arterial chemoembolization) Ctace (conventional trans arterial chemoembolization) DEB-TACE (drug-eluting bead trans arterial chemoembolization) PSM (propensity score matching) OS (overall survival) ECOG, (Eastern Cooperative Oncology Group) PFS, (progression-free survival rate) RFS (recurrence-free survival rate).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of enrolled patients in each included studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"13\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003estudy ID\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003enumber of patients\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMaximal tumor size\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePlatelet count,X(10)9/L\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal bilirubin level, mg/dL\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ealpha-Fetoprotein level, ng/mL\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHBV\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eHCV\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eALCOHOLIC\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eTumor number\u003c/p\u003e \u003cp\u003esolitary/multiple\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChok et al. 2006\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (47–85)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28(70)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e104.7\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e646\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e31/40 (78)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (42–77)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38(76)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e116.5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e495\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e42/51 (82)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYang Hsu et al. 2011\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 ± 10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e205 (65)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76 (35)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.06 ± 0.6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1629 ± 18,276\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e89 (41)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e103 (48)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e22 (10)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e24 / 8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e315\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 ± 11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e152 (71)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68 (22)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.05 ± 1.0\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e293 ± 1277\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e153 (49)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e138 (44)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e30 (10)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e150 /60\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYang et al. 2014\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.0 ± 9.5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49(74.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e113 ± 62\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.14 ± 0.54\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.2 ± 9.2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59(74.68)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e112 ± 52\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.27 ± 0.71\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKim et al. 2014\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.3 ± 9.4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98(80.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 ± 4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e89 (73)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e18 (14.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e11 (9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.7 ± 8.9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e123(74.54)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 ± 3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e116 (70.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e23 (14)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e16 (9.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLiu et al. 2014\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e282\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.70 ± 10.30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e192(68.08)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.16 ± 0.83\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1348.7 ± 16050.78\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e136/64\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e424\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.256 ± 11.52\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e278(65.56)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.07 ± 1.08\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e307.31 ± 1315.55\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e159/41\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSONG et al. 2016\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (23 − 87.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53(74.64)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e110 ± 50\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.2 ± 1.9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e24.9 (1.7–25,714.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e41/30\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (35–88)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31(72.09)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e114 ± 57\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.27 ± 1.4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14.4 (1.9–1,210.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e35/8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChen et al. 2016\u003c/p\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e311\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e≤ 58\u003c/p\u003e \u003cp\u003eN = 160\u003c/p\u003e \u003cp\u003e\u0026gt; 58\u003c/p\u003e \u003cp\u003eN = 151\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e174(55.94)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e84/19\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e338\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e≤ 58\u003c/p\u003e \u003cp\u003eN = 167\u003c/p\u003e \u003cp\u003e\u0026gt; 58\u003c/p\u003e \u003cp\u003eN = 171\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e181(53.55)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e217\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e80/23\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHocquelet et al. 2016\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 ± 11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47 (77)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31 (10)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e121 (81–160)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10 (4–43)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e14 (23)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e42/19\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 ± 11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50 (82)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30.2 (10)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e122 (86–162)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10 (5–42)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e13 (21)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e47/14\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLee et al. 2017\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64 ± 8.1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e111 (74.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40 (31–50)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e115 (33–461)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.9 (0.2–3.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e26.9 (1–3.5104)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e94 (62.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 (5.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e13 (8.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.5 ± 12.5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (80.56)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38 (31–50)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e136 (19–287)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.8 (0.1–1.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11.9 (1–1.3104)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e24 (66.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e13 (8.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6 (16.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIshikawa et al. 2018\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71 (48–88)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19(59.37)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 (8–45)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.1 (2.8–34.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.1 (0.4–2.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e15.0 (2.5-4,306)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e24/8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e210\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71 (37–85)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e131(62.38)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (5–38)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.5 (3.1–29.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.0 (0.4–3.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12.7 (1.6–12,916)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e150/60\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLee et al. 2018\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.8 ± 12.4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19(61.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.6 ± 11.5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.22 ± 0.66\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e198.97 ± 418.18\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e13 (41.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e13 (41.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4 (12.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e20 /11\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.5 ± 12.8\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (69.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.3 ± 8.8\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.91 ± 0.41\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e178.45 ± 479.66\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e26 (60.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e18 (41.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2 (4.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e28 / 15\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMARTIN et al. 2019\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.6 ± 8.7\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (70.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (13–27)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12 (4.4–34.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e15 (55.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e27\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.1 ± 11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (55.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (14–23)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17 (3.4–64.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12 (46.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChu et al. 2019\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e314\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.5 ± 10.6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e224 (77.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38 ± 5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.13 ± 0.61\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e57 (18.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e221 (70.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e40 (12.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.1 ± 10.8\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90 (78.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35 ± 4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.2 ± 0.74\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17 (14.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e74 (64.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e14 (23)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYun et al. 2020\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e268\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.3 ± 9.0\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e193(72.01)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28.3 ± 11.1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e117 ± 50.9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e181.9 ± 625.3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.1 ± 10.1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e102(75)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.8 ± 6.9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e128 ± 59.9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e159.5 ± 494.4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHyun Oh et al. 2020\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (54.5–67)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e112 (79.43)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e107.0 (82.0–143.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13.1 (6.3–51.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.0 (51.0–68.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72(82.758)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e116.0 (87.0–157.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11.8 (5.4–55.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKim et al. 2021\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (43–84)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12(57.14)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 ((10.0–30.0))\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e138 (47–287)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.81 (0.41–1.49)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.23 (1.65-3,340)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (47–76)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15(78.94)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (10.0–30.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e89 (34–244)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.0 (0.23-4.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14.01 (1.52-5,845)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTay et al. 2022\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e168\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 (57–75)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e123(73.21)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38 (22–62)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e128.0 (91.0–211.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.18 [0.11–0.29]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e18.0 [5.0–122.0]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e95/71\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (59–70)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43(76.78)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21 (15–27)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e132.5 (82.5–171.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.19 [0.12–0.38]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12.5 (7.0–58.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e34/ 22\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYein Ho et al. 2022\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e337\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 \u003cem\u003e±\u003c/em\u003e 11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e225(66.76)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100 (71–151)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.9[0.6–1.4]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e21 [7–112]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e236/101\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e546\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 \u003cem\u003e±\u003c/em\u003e 11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e351(64.28)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e114 (86–163)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.8 [0.5–1.2]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6 (16–65)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e191\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e454/92\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"13\"\u003eData are expressed as median (range), mean ± SD or Median [IQR value]]\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Quality assessment\u003c/h2\u003e \u003cp\u003eIn our analysis, the quality of the articles was appraised by the Newcastle-Ottawa Scale (NOS). The NOS was a standardized instrument to appraise and rate each research quality based on specific criteria relevant to study design, methodology, and potential biases. The NOS assessment findings exposed that most of the included articles (16/18) scored ≥ 7 as good quality, in terms of study group selection, comparison of groups, and outcome assessment. The average NOS score was seven out of nine, indicating a relatively high level of methodological quality and a low risk of bias. However, a few studies have identified limitations, such as the representativeness of the exposed cohort and adequacy of follow-up of cohorts, which may have affected their NOS scores. The details of the quality assessment results for these studies can be found in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eMethodological quality assessment of the included 18 studies, based on the NOS for assessing the quality of observational studies.\u003c/em\u003e Cohort studies (n = 18)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelection\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eComparability\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRepresentativeness of the exposed cohort\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSelection of the non-exposed cohort\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAscertainment of exposure\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOutcome was not present at start of study\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eControl for 2 important factors\u003csup\u003e2,3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAssessment of outcome\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFollow-up long enough\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eAdequacy of follow-up of cohort\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChok et al. 2006\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYang Hsu et al. 2011\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYang et al. 2014\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKim et al. 2014\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiu et al. 2014\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSONG et al. 2016\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChen et al. 2016\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHocquelet et al. 2016\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLee et al. 2017\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIshikawa et al. 2018\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLee et al. 2018\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMARTIN et al. 2019\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChu et al. 2019\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYun et al. 2020\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyun Oh et al. 2020\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKim et al. 2021\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTay et al. 2022\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYein Ho et al. 2022\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003e1\u003c/sup\u003e If the cases data was obtained from records with mentioning the process to extract information, or reference to primary record, a point was assigned.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003e2\u003c/sup\u003e If adjusted for age, a point was assigned.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003e3\u003c/sup\u003e If adjusted for drugs (e.g. anti-hypertensives, anti-diabetics etc) or any other additional factors, a point was assigned.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003e4\u003c/sup\u003e If information were obtained through national registries or hospital records, a point was assigned.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003e4\u003c/sup\u003e If information were obtained from patients and the difference in non-response rate between groups was 20% or less a point was assigned.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003e5\u003c/sup\u003e If the exposure data was obtained from prescription database or medical record, a point was assigned.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003e6\u003c/sup\u003e If the study design is prospective study, a point was assigned.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003e7\u003c/sup\u003e If the completeness of follow-up was 80% or more, a point was assigned.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Publication bias\u003c/h2\u003e \u003cp\u003eThrough visualization of the funnel plot, we found a significant publication bias.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.5. Clinical outcomes\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.5.1. Overall Survival (OS)\u003c/h2\u003e \u003cp\u003eSeventeen studies assessed the one-year overall survival (OS) rates, while seventeen and fifteen studies evaluated the three- and five-year OS rates, respectively. The pooled analysis of the one-year OS rates, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, focused on the \u003cb\u003eearly-stage HCC\u003c/b\u003e patients who underwent TACE and revealed no significant risk reduction compared to those who underwent RFA (RR = 0.97 (95% CI [0.95, 1.00]; p = 0.09).\u003c/p\u003e \u003cp\u003eThough, the three years and five years \u003cb\u003e(Supplementary Figures \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e and S 2)\u003c/b\u003e pooled analyses exposed a significant rise in Overall Survival favoring RFA with RR = 0.85 (95% CI [0.78, 0.92], p \u0026lt; 0.00001) and RR = 0.80 (95% CI [0.73, 0.89], p \u0026lt; 0.0001), respectively. High heterogeneity was observed (p = 0.002, I2 = 57%), (p \u0026lt; 0.00001, I2 = 74%), and (p = 0.0005, I2 = 63%), respectively, which could not be resolved by sensitivity analysis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003eSubgroup analysis\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eWe performed subgroup analysis to assess the impact of \u003cb\u003eage\u003c/b\u003e, alpha-fetoprotein (\u003cb\u003eAFP\u003c/b\u003e) levels, \u003cb\u003echemotherapy\u003c/b\u003e, and \u003cb\u003etumor size \u0026lt; 3\u003c/b\u003e cm on OS; detailed findings for each subgroup are presented in \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ethe results of the subgroup analysis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eAnalysis\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRR and 95%CI\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eHeterogeneity\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNo. of studies\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall survival after 1 year\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97 95% CI [0.95, 1.00]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.002\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 57%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLeave one out after 1 year sub grouped by age\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 60 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0295% CI [0.99, 1.05]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.29\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 41%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 60 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.93, 95% CI [0.91, 0.96]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.00001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP = 0.19\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 30%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall survival after 3 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.85 (95% CI [0.78, 0.92]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.00001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep \u0026lt; 0.00001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 74%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLeave one out after 3 years sub grouped by age\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 60 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.86, 95% CI [0.75, 0.98]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.03\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.002\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 57%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 60 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.84, 95% CI [0.78, 0.89]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.00001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.40\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 3%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall survival after 5 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80(95% CI [0.73, 0.89]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.0001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.0005,\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 63%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLeave one out after 5 years sub grouped by age\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 60 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.84(95% CI [0.75, 0.93]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 18%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB ≥ 60 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.82, 95% CI [0.77, 0.87]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.00001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.51\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 0%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall survival after 1 year\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97 95% CI [0.95, 1.00]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.002\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 57%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLeave one out after 1 year sub grouped by alpha-fetoprotein\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAFP \u0026lt; 100 ng/mL\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98, 95% CI [0.93, 1.04]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.58\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.0003\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 73%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAFP ≥ 100 ng/mL\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.95, 95% CI [0.92,0.98]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.0009\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP = 0.89\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 0%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall survival after 3 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.85 (95% CI [0.78, 0.92]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.00001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep \u0026lt; 0.00001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 74%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLeave one out after 3 years sub grouped by alpha-fetoprotein\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAFP \u0026lt; 100 ng/mL\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.79, 95% CI [0.69, 0.90]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.0003\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.24\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 25%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAFP ≥ 100 ng/mL\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.82, 95% CI [0.75,0.87]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.0001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP = 0.42\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 0%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall survival after 5 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80(95% CI [0.73, 0.89]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.0001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.0005,\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 63%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLeave one out after 5 years sub grouped by alpha-fetoprotein\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAFP \u0026lt; 100 ng/mL\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.79(95% CI [0.69, 0.90]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.0003\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.24\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 25%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAFP ≥ 100 ng/mL\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.82, 95% CI [0.75,0.87]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.0001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP = 0.42\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 0%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall survival after 1 year\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97 95% CI [0.95, 1.00]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.002\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 57%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLeave one out after 1 year sub grouped by chemotherapy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdriamycin\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.94, 95% CI [0.91, 0.96]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.00001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP = 0.59\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 0%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoxorubicin hydrochloride\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02, 95% CI [0.95, 1.09]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.65\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.19\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 41%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall survival after 3 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.85 (95% CI [0.78, 0.92]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.00001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep \u0026lt; 0.00001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 74%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLeave one out after 3 years sub grouped by chemotherapy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdriamycin\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.85, 95% CI [0.80, 0.90]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.00001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP = 0.43\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 0%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoxorubicin hydrochloride\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRR 0.66, 95% CI [0.58, 0.76]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.00001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.62\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 0%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall survival after 5 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80(95% CI [0.73, 0.89]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.0001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.0005,\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 63%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLeave one out after 5 years sub grouped by chemotherapy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdriamycin\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRR 0.81, 95% CI [0.74, 0.88]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep \u0026lt; 0.00001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP = 0.33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 12%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoxorubicin hydrochloride\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.76, 95% CI [0.42, 1.37]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.36\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.005\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 68%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall survival after 1 year\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97 95% CI [0.95, 1.00]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.002\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 57%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLeave one out after 1 year sub grouped by tumor size \u0026lt; 3 cm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRR 0.96, 95% CI [0.87, 1.06]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.40\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 52%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall survival after 3 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97 95% CI [0.95, 1.00]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.002\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 57%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLeave one out after 3 years sub grouped by tumor size \u0026lt; 3 cm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81, 95% CI [0.67, 0.99]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.03\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 33%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall survival after 5 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97 95% CI [0.95, 1.00]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.002\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 57%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLeave one out after5 years sub grouped by tumor size \u0026lt; 3 cm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81(95% CI [0.70, 0.94]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep = 0.005\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep = 0.41\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI2 = 0%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eIn the subgroup analysis based on \u003cb\u003eage\u003c/b\u003e, in patients \u003cb\u003eaged \u0026lt; 60 years\u003c/b\u003e, no significant differences in OS at one year were observed between TACE and RFA (RR 1.02, 95% CI [0.99, 1.05], p = 0.29). The results were homogenous (P = 0.10). However, the three years and five years pooled analyses exposed a significant rise in OS favoring RFA (RR = 0.86, 95% CI [0.75, 0.98], p = 0.03) and RR = 0.84 (95% CI [0.75, 0.93], p = 0.001), respectively. High heterogeneity was noted (p \u0026lt; 0.0001, I2 = 77%), and (p = 0.03, I2 = 57%), respectively; sensitivity analysis could not resolve at three years but resolved at five years excluding SONG et al. 2016 (p = 0.30, I2 = 18%).\u003c/p\u003e \u003cp\u003eIn patients \u003cb\u003eaged ≥ 60 years\u003c/b\u003e, RFA showed a significant increase in OS compared with TACE (RR = 0.93, 95% CI [0.91, 0.96], p \u0026lt; 0.00001) at one year, (RR = 0.84, 95% CI [0.78, 0.89], p \u0026lt; 0.00001) at three years, (RR = 0.82, 95% CI [0.77, 0.87], p \u0026lt; 0.00001) at five years. The results were homogenous at one year (P = 0.19) and five years (p = 0.51), while heterogeneity was observed at three years (p = 0.0005, I2 = 73%). The heterogeneity was resolved by sensitivity examination eliminating Hocquelet et al.2016 (p = 0.40, I2 = 3%)\u003c/p\u003e \u003cp\u003eOne-year subgroup difference test was Chi² = 16.75, df = 1 (P \u0026lt; 0.0001, I² = 94.0%), three-year was Chi² = 0.08, df = 1 (P = 0.78, I² = 0%), and five-year was Chi² = 0.46, df = 1 (P = 0.50, I² = 0%).\u003c/p\u003e \u003cp\u003eIn the subgroup analysis based on \u003cb\u003eAFP levels\u003c/b\u003e, patients with an Alpha-fetoprotein (\u003cb\u003eAFP \u0026lt; 100 ng/mL)\u003c/b\u003e showed no significant differences in OS at one year between TACE and RFA (RR = 0.98, 95% CI [0.93, 1.04], p = 0.58). The results were heterogeneous (p = 0.0003, I2 = 73%) and could not be resolved by sensitivity analysis.\u003c/p\u003e \u003cp\u003eNonetheless, the pooled analyses for the three-year and five-year overall survival demonstrated a significant improvement in favor of radiofrequency ablation (RFA) concerning treatment outcomes. The three-year pooled analysis yielded a risk ratio (RR) of 0.79 (95% CI [0.69, 0.90], p = 0.0003), while the five-year pooled analysis occasioned an RR of 0.79 (95% CI [0.69, 0.90], p = 0.0003). Both analyses exhibited high heterogeneity (p \u0026lt; 0.00001, I2 = 83% for three years; p = 0.006, I2 = 64% for five years). However, through sensitivity analysis, excluding the study conducted by SONG et al. in 2016, the heterogeneity was substantially resolved, resulting in p-values of 0.24 and I2 values of 25% for both the three-year and five-year analyses, respectively.\u003c/p\u003e \u003cp\u003eIn contrast, patients with \u003cb\u003eAFP ≥ 100 ng/mL\u003c/b\u003e showed significant differences in OS, favoring RFA (RR = 0.95, 95% CI [0.92, 0.98], p = 0.0009) at one year, (RR = 0.82, 95% CI [0.75, 0.87], p \u0026lt; 0.0001) at three years, and (RR = 0.82, 95% CI [0.75,0.87], p \u0026lt; 0.0001) at five years. The results were homogenous at one year (P = 0.89), three years (P = 0.42), and five years (P = 0.42).\u003c/p\u003e \u003cp\u003eOne-year subgroup difference test was Chi² = 1.40, df = 1 (P \u0026lt; 0.24, I² = 28.4%), three-year was Chi² = 0.02, df = 1 (P = 0.87, I² = 0%), and five-year was Chi² = 0.27, df = 1 (P = 0.60, I² = 0%).\u003c/p\u003e \u003cp\u003eFurthermore, in the subgroup analysis based on \u003cb\u003echemotherapy\u003c/b\u003e, patients who received \u003cb\u003eAdriamycin\u003c/b\u003e showed a significant increase in OS, favoring RFA (RR = 0.94, 95% CI [0.91, 0.96], p \u0026lt; 0.00001) at one year, (RR = 0.85, 95% CI [0.80, 0.90], p \u0026lt; 0.00001) at three years, (RR = 0.81, 95% CI [0.74, 0.88], p \u0026lt; 0.00001) at five years. The results were homogenous at one year (P = 0.59), three years (P = 0.43), and five years (P = 0.33).\u003c/p\u003e \u003cp\u003eIn comparison, patients who received \u003cb\u003eDoxorubicin\u003c/b\u003e hydrochloride with TACE had no significant difference in OS at one year and five years between TACE and RFA (RR = 1.02, 95% CI [0.95, 1.09], p = 0.65) and (RR = 0.76, 95% CI [0.42, 1.37], p = 0.36), respectively. However, the three years pooled analyses exposed a significant rise in \u003cb\u003eOverall\u003c/b\u003e Survival favoring RFA (RR = 0.66, 95% CI [0.58, 0.76], p \u0026lt; 0.00001). High heterogeneity was observed at one year ( p = 0.09, I2 = 53%), and three years ( p \u0026lt; 0.00001, I2 = 94%), resolved by sensitivity investigation rejecting MARTIN et al.2019at one year (p = 0.19, I2 = 41%) and Hocquelet et al. 2016 at three years (p = 0.62, I2 = 0%), while the heterogeneity at five years ( p = 0.005, I2 = 68%) could not be resolved by the leave-one-out test because we had three articles only in this analysis.\u003c/p\u003e \u003cp\u003eOne-year subgroup difference test was Chi² = 4.47, df = 1 (P \u0026lt; 0.03, I² = 77.6%), three-year was Chi² = 10.53, df = 1 (P = 0.001, I² = 90.5%), and five-year was Chi² = 0.04, df = 1 (P = 0.84, I² = 0%).\u003c/p\u003e \u003cp\u003eIn subgroup investigation related to \u003cb\u003etumor size less than 3 cm\u003c/b\u003e, no significant differences in OS at one year were observed between TACE and RFA (RR = 0.96, 95% CI [0.87, 1.06; p = 0.40). However, the three years and five years pooled analyses exposed a significant rise in Overall Survival favoring RFA (RR = 0.81, 95% CI [0.67, 0.99], p = 0.03) and RR = 0.81(95% CI [0.70, 0.94], p = 0.005), respectively. High heterogeneity was observed at one year (p \u0026lt; 0.00001, I2 = 91%), three years (p = 0.02, I2 = 65%), and five years (p = 0.03, I2 = 62%), which were resolved by sensitivity investigation eliminating Yang Hsu et al. 2011 at one year (p = 0.10, I2 = 52%), SONG et al. 2016 at three years (p = 0.21, I2 = 33%), and SONG et al. 2016 at five years (p = 0.41, I2 = 0%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.5.2. Progression-free survival rate (PFS)\u003c/h2\u003e \u003cp\u003eAll rates of the one-, three-, and five-year progression-free survival (PFS) were assessed in a total of seven, seven, and six studies, respectively. Pooled analysis at one, three, and five years (\u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e) and (Supplementary Figures \u003cspan refid=\"MOESM3\" class=\"InternalRef\"\u003eS3\u003c/span\u003e and S4))\u003c/b\u003e established that the \u003cb\u003eearly-stage HCC patients\u003c/b\u003e who undertook TACE revealed no significant risk reduction compared to those who underwent RFA with RR = 1.48(95% CI [0.78, 2.83], p = 0.23) at one year, RR = 1.16 (95% CI [0.59, 2.26], P = 0. 67) at three years and RR = 1.21 (95% CI [0.66 to 2.23], P = 0. 54)at five years. High heterogeneity was observed (p \u0026lt; 0.00001, I2 = 91%), (p \u0026lt; 0.00001, I2 = 93%), and (p \u0026lt; 0.00001, I2 = 93%) respectively, which could not be resolved by using sensitivity analysis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003e3.5.3. The recurrence-free survival rate (RFS)\u003c/h2\u003e \u003cp\u003eIn eight studies, the 1-, 3-, and 5-year RFS rates were evaluated. Pooled analysis at one, three, and five years (\u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e) and (Supplementary Figures \u003cspan refid=\"MOESM5\" class=\"InternalRef\"\u003eS5\u003c/span\u003e and S6))\u003c/b\u003e showed that the risk reduction didn’t significantly differ between TACE and RFA among \u003cb\u003eHCC\u003c/b\u003e patients in the \u003cb\u003eearly stage\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe risk ratios (RR) for TACE compared to RFA were 1.12 (95% CI [0.86–1.46], p = 0.39) at one year, 0.93 (95% CI [0.64–1.37], p = 0.73) at three years, and 1.02 (95% CI [0.79–1.31], p = 0. 88) at five years. High heterogeneity was observed (p \u0026lt; 0.0001, I2 = 77%), (p \u0026lt; 0.00001, I2 = 85%), and (p \u0026lt; 0.0001, I2 = 77% respectively, which sensitivity analysis could not resolve.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003e3.5.4. Overall Survival propensity score-matching (OS-PSM) cohort\u003c/h2\u003e \u003cp\u003eTen studies were included to evaluate the one-, three-, and five-year overall survival in patients who underwent (TACE) for early-stage (HCC). The pooled analysis of the one-year OS-PSM rates, as depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, focused on examining the outcomes of these patients, revealed no significant risk reduction compared to those who underwent RFA with an RR of 0.99 (95% CI 0.95, 1.02], p = 0.45).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eHowever, the three years and five years \u003cb\u003e(Supplementary Figures \u003cspan refid=\"MOESM7\" class=\"InternalRef\"\u003eS7\u003c/span\u003e and S8)\u003c/b\u003e, pooled analyses revealed a significant increase in Overall Survival favoring RFA with RR = 0.91 (95% CI [0.85, 0.96], p = 0.001) and RR = 0.85(95% CI [0.79, 0.92], p \u0026lt; 0.001), respectively. High heterogeneity was observed (p \u0026lt; 0.00001, I2 = 93%), (p = 0.06, I2 = 46%), and (p = 0.06, I2 = 45%), respectively, which was resolved by sensitivity investigation rejecting Chu et al. 2019 at one year (p = 0.25, I2 = 22%), Yun et al. 2020 at three years (p = 0.48, I2 = 0%), and Chu et al. 2019 at five years (p = 0.59, I2 = 0%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003e3.5.5. The recurrence-free survival rate propensity-score matching (RFS-PSM) cohort\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFive studies were included to evaluate the one-, three-, and five-year overall survival in patients who underwent (TACE) for early-stage (HCC). The pooled analysis of the one-year RF-PSM rates, as depicted in \u003cb\u003eFig.\u0026nbsp;6\u003c/b\u003e, focused on examining the outcomes of these patients, and revealed no significant risk reduction compared to those who underwent RFA with an RR of 1.22 (95% CI [0.87, 1.70], p = 0.25).\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 6.\u003c/b\u003e The forest plot that demonstrates recurrence-free survival rate propensity score-matching cohort at 1 year\u003c/p\u003e \u003cp\u003eHowever, the three years and five years \u003cb\u003e(Supplementary Figures \u003cspan refid=\"MOESM9\" class=\"InternalRef\"\u003eS9\u003c/span\u003e and S10)\u003c/b\u003e pooled analyses revealed a significant increase in RFS-PSM favoring TACE with RR = 1.32(95% CI [1.10, 1.60], p = 0.003) and RR = 1.26(95% CI [1.10, 1.46], p = 0.001), respectively.\u003c/p\u003e \u003cp\u003eHigh heterogeneity was observed (p = 0.001, I2 = 78%) at one year, which could not be resolved by sensitivity analysis (p = 0.008, I2 = 71%) at three years, and (p = 0.09, I2 = 50%) at five years resolved by sensitivity analysis eliminating Hyun Oh et al. 2020 at three years (p = 0.26, I2 = 25%) and Yun et al. 2020at five years (p = 0.32, I2 = 15%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003e3.5.6. Tumor response\u003c/h2\u003e \u003cp\u003eThe tumor response outcomes, including complete response (CR), partial response (PR), stable response (SR), and progressive disease (PD), were evaluated in ten studies for complete response, five studies for partial response, five studies for stable disease, and five studies for progressive disease. The findings showed that \u003cb\u003eearly-stage HCC\u003c/b\u003e patients who undertook RFA had a meaningfully greater CR rate than those who underwent TACE, with a pooled risk ratio (RR) of 0.79(95% CI, 0.68, 0.91], p = 0.0009). \u003cb\u003e(Supplementary Figure \u003cspan refid=\"MOESM11\" class=\"InternalRef\"\u003eS11\u003c/span\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eElevated heterogeneity was reported (p \u0026lt; 0.00001, I2 = 95%), which could not be resolved by sensitivity analysis. There was a significant difference in PR in favor of TACE, with a pooled RR of 5.27(95% CI [3.06, 9.06]; p \u0026lt; 0.00001) \u003cb\u003e(Supplementary Figure \u003cspan refid=\"MOESM12\" class=\"InternalRef\"\u003eS12\u003c/span\u003e)\u003c/b\u003e. The results were homogeneous (P = 0.84). There was also a significant difference in the SR in favor of TACE, with a pooled RR of 7.31(95% CI [2.62, 20.45], p = 0.0001) \u003cb\u003e(Supplementary Figure \u003cspan refid=\"MOESM13\" class=\"InternalRef\"\u003eS13\u003c/span\u003e)\u003c/b\u003e. The result was homogenous (P = 0.97) However, the two interventions had no significant difference in PD, with PD of 1.67 (95% CI [0.65, 4.31], p = 0.29) \u003cb\u003e(Supplementary Figure \u003cspan refid=\"MOESM14\" class=\"InternalRef\"\u003eS14\u003c/span\u003e)\u003c/b\u003e. The result was homogenous (P = 0.44)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003e3.5.7 Adverse effects\u003c/h2\u003e \u003cp\u003e The analysis of adverse event rates did not reveal a significant reduction in risk between transarterial chemoembolization (TACE) and radiofrequency ablation (RFA), with a risk ratio (RR) of 1.01 (95% CI [0.41, 2.53], p = 0.98). However, it is important to note that high heterogeneity was observed (p = 0.08, I2 = 47%), which was subsequently resolved through sensitivity analysis by excluding the study conducted by Chu et al. in 2019 (p = 0.19, I2 = 33%). Furthermore, the analysis of total deaths also indicated no significant risk reduction between TACE and RFA, with an RR of 1.13 (95% CI [0.97, 1.30], p = 0.11). These findings are illustrated in Figs.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e7\u003c/span\u003e and \u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e8\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe studies included in the analysis assessed the outcome of death due to liver failure in patients who underwent either (TACE) or (RFA). In the TACE group, 1–2 patients died from liver failure, however, in the RFA group, 1–16 patients experienced the same outcome, and 1–3 patients experienced a pneumothorax.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur review proposed to compare the effectiveness of each TACE and RFA treatment for HCC. In this meta-analysis, after comparing TACE with RFA, we found that RFA had better 3-year and 5-year overall survival (OS). Additionally, there was no significant difference in one year except, in patients \u003cb\u003eaged ≥ 60 years\u003c/b\u003e, those \u003cb\u003ewith AFP ≥ 100 ng/ml or\u003c/b\u003e who received \u003cb\u003eAdriamycin\u003c/b\u003e, RFA had better 1-year OS. Also, RFA had better 3- and 5-year overall survival propensity score-matching (OS-PSM).\u003c/p\u003e\u003cp\u003eThere was a significant difference between age and chemotherapy groups at one-year (P \u0026lt; 0.0001, I² = 94.0%), and (P \u0026lt; 0.03, I² = 77.6%) respectively. Also, chemotherapy subgroups significantly differed at three-year (P = 0.001, I² = 90.5%).\u003c/p\u003e\u003cp\u003eHowever, there was no significant difference between TACE and RFA in the recurrence-free survival rate (RFS) or the progression-free survival rate (PFS).\u003c/p\u003e\u003cp\u003eIn contrast, 3- and 5-year pooled analyses revealed a significant increase in the recurrence-free survival rate propensity-score matching (\u003cb\u003eRFS-PSM\u003c/b\u003e) cohort regarding \u003cb\u003eTACE\u003c/b\u003e with RR = 1.32(95% CI [1.10, 1.60], p = 0.003) and RR = 1.26(95% CI [1.10, 1.46], p = 0.001), respectively.\u003c/p\u003e\u003cp\u003eIn contradiction of another meta-analysis, Gui et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) demonstrated that resection (SR) had superior 3- and 5-year disease-free survival (DFS) compared to a combination of TACE and RFA, without any significant impact on overall survival. Similarly, in a different meta-analysis conducted by Wang et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), the TACE and RFA combination exhibited improved 1-year overall survival (OS) (OR = 1.88, p = 0.02) compared to resection (SR), without significant difference in 3- and 5-year DFS.\u003c/p\u003e\u003cp\u003eRegarding the tumor response outcomes, \u003cb\u003eRFA\u003c/b\u003e had a meaningfully greater complete response (\u003cb\u003eCR\u003c/b\u003e) rate than those who underwent TACE, with a pooled risk ratio (RR) of 0.79(95% CI, 0.68, 0.91], p = 0.0009). Though, partial response (\u003cb\u003ePR\u003c/b\u003e) and stable response (\u003cb\u003eSR\u003c/b\u003e) significantly differ regarding \u003cb\u003eTACE\u003c/b\u003e, with a pooled RR of 5.27(95% CI [3.06, 9.06]; p \u0026lt; 0.00001) and RR of 7.31(95% CI [2.62, 20.45], p = 0.0001), respectively.\u003c/p\u003e\u003cp\u003eThese findings have significant implications for the management of HCC and contribute to redefining the TACE role. In the past, TACE has often been used as a comforting HCC therapy. However, it is important to note that TACE does not solely provide palliation for tumor-related symptoms (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Studies have demonstrated that the combination of TACE and RFA yields comparable overall survival (OS) and disease-free survival (DFS) outcomes in recurrent HCC patients (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Additionally, TACE as a standalone therapy has been stated to recover survival consequences in intractable HCC (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). These findings underline the potential benefits and effectiveness of TACE in the management of HCC beyond its palliative perception.\u003c/p\u003e\u003cp\u003eAlthough the adverse event rate and mortality rate didn’t significantly differ in TACE than in RFA, patients died from liver failure in the TACE group lower than in the RFA group. In addition, there were 1–3 patients who experienced a pneumothorax in the RFA group. However, the two interventions had no significant difference in progressive disease (PD).\u003c/p\u003e\u003cp\u003eIn Gui et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) meta-analysis, Surgical resection (SR) was linked to an extended duration of hospitalization and a higher occurrence of significant problems compared to the combination of TACE and RFA.\u003c/p\u003e\u003cp\u003eThe articles in this meta-analysis didn’t report the quality of life (QoL). Earlier investigations focusing on TACE have indicated that various factors influence QoL experienced by patients. These factors include patient-related aspects such as psychosocial support, disease-related aspects like hepatic dysfunction, illness progress, and problems, as well as therapy-related aspects including adverse events and lengthy hospital stays (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough the present study showed RFS has better OS than TACE, TACE showed safety evidence over RFS. In contrast, there were some disadvantages of TACE including; a higher local tumor recurrence rate compared to LR or RFA (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), an increased liver failure risk in cases with Child-Pugh B or C cirrhosis (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), the potential for portal vein thrombosis (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), and the occurrence of post-embolization syndrome (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur study defined that TACE as a monotherapy doesn’t be the drug of choice for early-stage HCC. Some alternatives showed better effects, including; MWA, PEI, and HIFU.\u003c/p\u003e\u003cp\u003eInitially, Microwave ablation (MWA) operates by inducing thermal energy through the agitation of water molecules and the generation of friction. It possesses certain advantages over radiofrequency ablation (RFA) such as a diminished heat sink effect and a shorter treatment duration (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). However, it exhibits diminished effectiveness in tumors larger than 5 cm (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), and the treatment outcomes may differ depending on the specific devices used (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe combination of MWA and RFA with TACE therapy has demonstrated enhanced local tumor control through multiple mechanisms. The incorporation of TACE alongside RFA is anticipated to decrease localized tumor progress by rejecting blood flow. Moreover, TACE can minimize thermal harm during the ablation process, thereby expanding the ablative region and enhancing the handling of potential micro-metastases surrounding the primary tumor (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn a prior study involving metastatic cases, RFA and TACE combination exhibited a local recurrence rate similar to that of resection (LR). However, when analyzing a single randomized controlled trial (RCT), RFA plus TACE demonstrated inferior overall survival (OS) and recurrence-free survival (RFS) compared to LR. Nevertheless, when examining non-randomized trials (NRTs), the outcomes between the two treatment groups were comparable (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMicrowave ablation (MWA) yielded comparable OS and RFS results to the LR group, although it displayed a higher incidence of local recurrence compared to LR. Additionally, MWA did not address the limitations of RFA, including its high local recurrence rate and suboptimal RFS (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe superiority of MWA compared to Liver Resection (LR) in terms of oncologic efficacy remains uncertain, as indicated by an analysis of several cohort studies (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Furthermore, there is insufficient evidence to establish whether MWA outperforms RFA using RFS and OS (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). A new study demonstrated that patients with microvascular invasion who underwent RFA had a higher risk of recurrence compared to those who underwent LR (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHence, in microvascular invasion risk patients, characterized by elevated serum tumor markers and prominent arterial peritumoral improvement (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), localized ablation treatment may not be the most suitable therapeutic option. This potential may contribute to the lower oncologic outcomes observed with RFA, RFA plus TACE, or MWA compared to LR.\u003c/p\u003e\u003cp\u003eSecond, Percutaneous ethanol injection (PEI) is a method of injecting ethanol into the tumor, resulting in coagulation necrosis. It exhibits the highest effectiveness in HCC cases that are smaller than 2 cm. PEI is a moderately priced, straightforward technique that holds appeal for regions with limited resources. It is also feasible in patients with cirrhosis and generally well-tolerated (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, PEI does have certain drawbacks. One limitation is the non-uniform distribution of ethanol within the tumor, particularly when septa are present (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Additionally, PEI is associated with higher rates of recurrence and inferior overall survival compared to ablative techniques (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). It requires multiple injections and is considered an outdated approach in some cases (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFinally, High-intensity focused ultrasound (HIFU) is an ultrasound-based technique that exerts both thermal effects, resulting from energy absorption, and non-thermal effects such as cavitation and boiling bubbles (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Currently, HIFU is primarily investigated as an experimental approach for patients with Child-Pugh cirrhosis as a bridge to liver transplantation (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). This modality offers selectivity and non-invasiveness, making it feasible to perform ablation near large blood vessels. Combining HIFU with TACE may prove to be a more active therapeutic choice for HCC cases measuring less than 5 cm than TACE alone (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, it is important to note that HIFU has limitations, including limited therapeutic windows between the ribs, which can result in reflection and unintended burns. Additionally, the treatment is significantly affected by respiratory motion, often requiring mechanical ventilation to mitigate disruptions (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOne notable strength of this meta-analysis is its unique distinction as the inaugural study of its type to incorporate propensity-matched articles subgroup analysis. Additionally, our analysis is superior to conducting a more detailed stratification of the recurrence of the tumor response outcomes, including (CR), (PR), (SR), and (PD). Furthermore, it is the first to analyze one tumor size \u0026lt; 3cm.\u003c/p\u003e\u003cp\u003eRegarding our analysis limitations, the predominance of retrospective articles introduces a heightened potential for bias, particularly in terms of patient selection. Additionally, therapeutic options are significantly affected by the availability of limited resources and expertise levels, which may limit the generalizability of the findings. Moreover, there was heterogeneity in most of the outcomes which was mainly affected by factors such as; age and previously taken chemotherapy. Then, we found publication bias in many studies. Finally, this study did not compare the hospital stay or the quality of life.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, the oncological outcomes of transarterial chemoembolization (TACE) were not superior to those of radiofrequency ablation (RFA) in patients who suffered hepatocellular carcinoma (HCC). These findings were affected by the heterogeneity which was mainly affected by factors such as; age and previously taken chemotherapy. However, TACE did provide the advantage of decreased morbidity and adverse effects. To reassess the position of TACE as a potentially curative option compared to RFA, additional well-designed multicenter randomized studies of high quality are necessary.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003col\u003e\n \u003cli\u003eHepatocellular Carcinoma (HCC)\u003c/li\u003e\n \u003cli\u003eTrans arterial chemoembolization (TACE)\u003c/li\u003e\n \u003cli\u003eRadiofrequency ablation (RFA)\u003c/li\u003e\n \u003cli\u003eProgression-free survival (PFS)\u003c/li\u003e\n \u003cli\u003eTumor response (TR)\u003c/li\u003e\n \u003cli\u003eAdverse event rate (AER).\u003c/li\u003e\n \u003cli\u003eHepatitis B virus (HBV)\u003c/li\u003e\n \u003cli\u003eHepatitis C virus (HCV)\u003c/li\u003e\n \u003cli\u003eThe preferred reporting items for systematic reviews and meta‐analyses (PRISMA)\u003c/li\u003e\n \u003cli\u003eRandomized controlled trials (RCTs)\u003c/li\u003e\n \u003cli\u003eNewcastle-Ottawa Scale (NOS)\u003c/li\u003e\n \u003cli\u003ePropensity-score matching (PSM)\u003c/li\u003e\n \u003cli\u003eRisk ratio (RR)\u003c/li\u003e\n \u003cli\u003eMean difference (MD)\u003c/li\u003e\n \u003cli\u003eComplete response (CR)\u003c/li\u003e\n \u003cli\u003ePartial response (\u003cstrong\u003ePR\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003eStable response (\u003cstrong\u003eSR\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003eProgressive disease (PD)\u003c/li\u003e\n \u003cli\u003eDisease-free survival (DFS)\u003c/li\u003e\n \u003cli\u003eMicrowave ablation (MWA)\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003e Mahmoud Shaban Abdelgalil\u003csup\u003e\u0026nbsp;\u003c/sup\u003ehas nothing to disclose. All the authors also declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e All author(s) received \u003cstrong\u003e\u003cem\u003eno\u003c/em\u003e\u003c/strong\u003e financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u003c/strong\u003e not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u003c/strong\u003e All data generated or analyzed during this study are included in this published article or in the data repositories listed in References.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability:\u003c/strong\u003e not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003eI dedicate this study to my parents and my sister for their endless love and support. I hope this achievement will fulfill the dreams they envisioned for me.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMahmoud Shaban Abdelgalil led the team, carried out the search strategy and data collection steps, resolved any conflicts during the screening phase, and resolved any conflicts during the quality evaluation phase, and did the analysis. Bahaa Elfakharany took part in the title and abstract screening, the full-text screening, data extraction and wrote the introduction. Mohamed El-Samahy\u003cstrong\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003etook part in the quality assessment, data extraction, and wrote the result section. Ibraheem M alkhawaldeh took part in the full-text screening, data extraction, and drafted the tables. Neveen Refaey contributed to the quality evaluation phase and wrote the method section. Saad Ashraf ALsaad was involved in the title and abstract screening, quality assessment, and data extraction. Dina Alaraby wrote the discussion section, the abstract and edited the manuscript.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLlovet JM, Singal AG, Villanueva A, et al. Prognostic and predictive factors in patients with advanced HCC and elevated alpha-fetoprotein treated with ramucirumab in two randomized phase III trials. Clin Cancer Res. 2022;28:2297\u0026ndash;305. \u003c/li\u003e\n\u003cli\u003eRumgay H, Arnold M, Ferlay J, Lesi O, et al. Global burden of primary liver cancer in 2020 and predictions to 2040. J Hepatol. 2022;77:1598\u0026ndash;606. \u003c/li\u003e\n\u003cli\u003eMcGlynn KA, Petrick JL, London WT. Global epidemiology of hepatocellular carcinoma: an emphasis on demographic and regional variability. Clin Liver Dis. 2015;19:223\u0026ndash;38. \u003c/li\u003e\n\u003cli\u003eRahib L, Smith BD, Aizenberg R et al. 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Br J Radiol. 2012;85(1018):e940\u0026ndash;6. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Trans Arterial Chemoembolization, Radiofrequency Ablation, Hepatocellular carcinoma, Early HCC, Liver cancer","lastPublishedDoi":"10.21203/rs.3.rs-3372637/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3372637/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePatients with hepatocellular carcinoma (HCC) may face challenges when undergoing radiofrequency ablation (RFA) if their tumors are located near critical liver regions, bile ducts, bowel lumen, or diaphragm due to increased risk of complications. In these cases, liver resection or transplantation is not possible; therefore, transarterial chemoembolization (TACE) can be an alternative treatment for early HCC patients. Our study aims to compare the efficacy and safety of TACE versus RFA.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe collected data from different sources, including Cochrane Library, PubMed, Scopus, and Web of Science. Our inclusion criteria were patients with a single tumor less than 5 cm or three tumors, each less than or equal to 3 cm in size, without spread or invasion. The review examined various factors such as overall survival (OS), recurrence-free survival rate (RFS), progression-free survival (PFS), tumor response (TR), and adverse event rate (AER).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eEighteen studies, involving 4,537 patients were reviewed. Pooled analysis revealed that RFA had better three-year and five-year OS rates compared to TACE (RR\u0026thinsp;=\u0026thinsp;0.85, 95% CI [0.78, 0.92], p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001; RR\u0026thinsp;=\u0026thinsp;0.80, 95% CI [0.73, 0.89], p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, respectively). However, for one-year OS, no significant difference was observed, except in specific subgroups (patients aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years, AFP\u0026thinsp;\u0026ge;\u0026thinsp;100 ng/ml, or received Adriamycin), where RFA showed better outcomes (RR\u0026thinsp;=\u0026thinsp;1.02, 95% CI [0.99, 1.05], p\u0026thinsp;=\u0026thinsp;0.29). Propensity score-matching analyses also demonstrated better three-year and five-year OS rates for RFA (RR\u0026thinsp;=\u0026thinsp;0.91, 95% CI [0.85, 0.96], p\u0026thinsp;=\u0026thinsp;0.001; RR\u0026thinsp;=\u0026thinsp;0.85, 95% CI [0.79, 0.92], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively).\u003c/p\u003e","manuscriptTitle":"Unraveling the Controversy: Transarterial Chemoembolization versus Radiofrequency Ablation in Early Hepatocellular Carcinoma - A Systematic Review and Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-10-10 18:10:50","doi":"10.21203/rs.3.rs-3372637/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0cb47376-8b98-4087-9f9c-e8afea8f9db9","owner":[],"postedDate":"October 10th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-11-07T02:29:20+00:00","versionOfRecord":[],"versionCreatedAt":"2023-10-10 18:10:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3372637","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3372637","identity":"rs-3372637","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}