Radiofrequency ablation with or without ethanol injection for hepatocellular carcinoma: a systematic review and meta-analysis

NTRODUCTION: To compare radiofrequency ablation (RFA) plus ethanol injection (EI) with RFA alone for hepatocellular carcinoma. EVIDENCE ACQUISITION: A comprehensive search of studies among PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Chinese BioMedical Literature Database (CBM) was conducted with published date from the earliest to May 1st, 2016. No language restrictions were applied, but only prospective randomized controlled trials (RCTs) or non-randomized controlled trials (non-RCTs) were eligible for a full-text review. Published trials that included a treatment group receiving RFA plus EI and a control group receiving RFA alone with data for at least 1-year survival or complete ablation rate were included. Pooled ORs with 95% confidence interval (CI) were calculated using either the fixed-effects model or random-effects model. All statistical analyses were carried out using Stata v. 12.0 (Stata Corporation, College Station, TX, USA). EVIDENCE SYNTHESIS: There were 8 trials (3 RCTs) involving 969 patients. Patients receiving RFA plus EI showed significantly better in 1-year survival rate (OR= 2.09, 95% CI: 1.38-3.01; P< 0.001), 2-year survival rate (OR= 21.84, 95% CI: 1.13-3.00; P= 0.014), 3-year survival rate (OR= 1.86, 95% CI: 1.35-2.57; P< 0.001) and complete ablation rate (OR= 2.34, 95% CI: 1.52-3.61; P< 0.001). CONCLUSIONS: RFA plus EI was superior than RFA alone for treating HCC.