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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma: A systematic review and meta-analysis
Myo Jin Tang, Guy D Eslick, John S Lubel, Ammar Majeed, Avik Majumdar, William Kemp, Stuart K Roberts
Myo Jin Tang, John S Lubel, Ammar Majeed, William Kemp, Stuart K Roberts, Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
Myo Jin Tang, Monash Medical School, Monash University, Melbourne 3004, Victoria, Australia
Guy D Eslick, Department of Statistics, Clued Pty Ltd, Sydney 2006, New South Wales, Australia
John S Lubel, Ammar Majeed, William Kemp, Stuart K Roberts, Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
Avik Majumdar, Department of Gastroenterology, Austin Hospital, Heidelberg 3084, Victoria, Australia
Avik Majumdar, Department of Medicine, Austin Campus, University of Medicine, Melbourne 3084, Victoria, Australia
Author contributions: Tang MJ performed the systematic review, acquisition and interpretation of the data, drafting the article, and final approval; Eslick GD performed the statistical analysis and interpretation of the data, drafting the article, and final approval; Lubel JS performed the systematic review, acquisition and interpretation of the data, drafting the article, and final approval; Majeed A performed interpretation of the data, review of the article, and final approval; Majumdar A contributed to the study design, interpretation of the data, review of the article, and final approval; Kemp W contributed to study concept and design, interpretation of the data, drafting and review of the article, and final approval; Roberts SK contributed to study concept and design, interpretation of the data, drafting and review of the article, and final approval.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Stuart K Roberts, FAASLD, AGAF, FRACP, MBBS, MD, Adjunct Professor, Department of Gastroenterology, Alfred Hospital, 99 Commercial Rd, Melbourne 3004, Victoria, Australia. s.roberts@alfred.org.au
Received: April 24, 2022
Peer-review started: April 24, 2022
First decision: June 19, 2022
Revised: July 1, 2022
Accepted: August 10, 2022
Article in press: August 10, 2022
Published online: August 28, 2022
ARTICLE HIGHLIGHTS
Research background
Hepatocellular carcinoma (HCC) is the seventh most common cancer and second leading cause of cancer mortality. Of the common modalities used to ablate HCC, radiofrequency ablation (RFA) is the most strongly recommended. Recently, microwave ablation (MWA) has become a popular ablative technique because of its reduction in heat-sink effect, ability to produce wider and more predictable ablation volumes.
Research motivation
Studies to date comparing outcomes of MWA with RFA have yielded conflicting results, with no clear superiority of one technique over the other. In this context, additional evidence particularly from a comprehensive meta-analysis that incorporate all RCTs and data from large real-world observational cohort studies would provide clinicians with a better understanding.
Research objectives
This study was a contemporary systematic review and meta-analysis of RCTs and cohort studies to determine whether MWA is equivalent to or more effective than RFA in relation to the primary treatment endpoints of complete ablation (CA), local recurrence rate (LRR), local recurrence-free survival, overall survival (OS), and safety including adverse events.
Research methods
A systematic electronic search was conducted independently by two authors. Quality of included studies were assessed using the Jadad scale for RCTs and Newcastle–Ottawa Scale for cohort studies. A random-effects model using the method of DerSimonian and Laird was used for each outcome. Meta-regression analysis was performed to adjust for the difference in follow-up period between the studies.
Research results
A total of 42 studies, eight RCTs and 34 cohort studies were included in the meta-analysis, allowing us to examine a total cohort of 6719 patients. CA rates between MWA and RFA groups were similar in prospective cohort and RCTs; however, retrospective studies reported higher rates with MWA. Retrospective cohort studies reported higher OS and lower LRR. MWA had an increased rate of adverse respiratory events when compared to RFA.
Research conclusions
MWA achieves similar CA rates and as good or better longer-term outcomes in relation to LRR and OS compared to RFA. Apart from an increased rate of respiratory events post procedure, MWA is as safe as RFA.
Research perspectives
Current literature on local recurrence free survival is lacking and has potential to be explored in future studies.
