The prognosis of ablative treatments and liver resection for early-stage hepatocellular carcinoma：a systematic review and Bayesian network meta

Objective: To compare overall survival (OS) rates and disease-free survival (DFS) rates following radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CA) and Liver resection (LR) for hepatocellular carcinoma (HCC). Method PubMed, SCI, and Cochrane databases were searched for literature until March 1st, 2023. The data obtained from the literature were netted using Stata 15.0 and R 4.2.3. The primary assessments of content were overall survival (OS) rates and disease-free survival (DFS) rates at 1 and 3 years. OS rates and DFS rates were reported as the hazard ratio (HR) with 95% confidence interval (95% CrI) to summarize the effect of each comparison. Result A total of 25 publications with 5247 patients were included, including 12 studies in mainland China and 13 in other regions. Overall outcomes: for one-year and three-year overall survival rates, there was no statistical difference between the groups compared; for one-year disease-free survival rates, the HR was 1.85 (95% CrI: 1.31–2.61) for LR compared with RFA; 1.76 (95% CrI: 1.22–2.54) for LR compared with MWA, with no statistical difference in the rest of the groups compared; for three-year disease-free survival rates, the HR was 1.92 (95% CrI: 1.38–2.66) for LR compared with RFA; 1.88 (95% CrI: 1.31–2.68) for LR compared with MWA, and the rest were not statistically significant. Conclusion For particularly early-stage hepatocellular carcinoma, ablative procedures have comparable therapeutic efficacy; LR is more effective in reducing tumor recurrence than interventional ablation.