Outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma: A systematic review and meta-analysis

doi:10.13105/wjma.v10.i4.220

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Meta-Analysis

World J Meta-Anal. Aug 28, 2022; 10(4): 220-237
Published online Aug 28, 2022. doi: 10.13105/wjma.v10.i4.220

Table 1 Summary of patient characteristics of included randomised controlled trials and cohort studies

Ref.	Design	Country	Year	Arms	NP	Age/yr	% males	NL	Tumour size, mean or median (range or SD)/mm	CPC (A/B/C)	F/U Duration/mo
Abdelaziz et al[72], 2014	RCT	Egypt	2009-2011	MWA	66	53.6 (48.6-58.6)	72.7	76	29 (19.3-38.7)	25/41/0	NR
				RFA	45	56.8 (49.5-64.1)	68.9	52	29.5 (19.2-39.8)	24/21/0
Chong et al[34], 2020	RCT	Hong Kong	2011-2017	MWA	47	63 (50–80)	63.8	NR	31 (20–45)	39/7/1	38.3 (2.3–78.0)
				RFA	46	64.5 (42–5)	82.6		28 (20–55)	40/6/0	33.9 (4.9–72.7)
Kamal et al[35], 2019	RCT	Egypt	2017	MWA	28	55 (42-80)	75	34	32.5 (23.3-41.7)	22/6/0	12
				RFA	28	55 (42-80)	78.6	34	32.8 (23.7-41.9)	22/6/0	12
Qian et al[36], 2012	RCT	China	2009-2010	MWA	22	52 (43–75)	90.9	22	21 (17-25)	22/0/0	5.1 ± 1.3 (2.8-6.5)
				RFA	20	56 (43–76)	95	20	20 (15-25)	20/0/0	5.1 ± 1.3 (2.8-6.5)
Shibata et al[23], 2002	RCT	Japan	1999-2000	MWA	36	62.5 (52–74)	66.7	46	22 (9–34)	19/17/0	18 (6-27)
				RFA	36	63.6 (44–83)	72.7	48	23 (10–37)	21/15/0	18 (6-27)
Tian et al[37], 2014	RCT	China	2014	MWA	120	NR	NR	86	26 (13-39)	NR	NR
				RFA				79	22 (13-31)
Vietti et al[38], 2018	RCT	France & Switzerland	2011-2015	MWA	76	NR	NR	98	NR	NR	26 (18-29)
				RFA	76			104			25 (18-34)
Yu et al[22], 2017	RCT	China	2008-2015	MWA	203	NR	NR	265	27 (7– 50)	NR	35.2 (2.0–81.9)
				RFA	200			251	26 (9–50)		35.2 (2.0–81.9)
Abdel-Samiee et al[33], 2020	Retro	Egypt	2020	MWA	50	NR	NR	NR	NR	NR	36
				RFA	50						36
Bouda et al[39], 2020	Retro	France	2008-2016	MWA	79	62.8 (52.4-73.2)	81	99	21.3 (13-29.6)	71/8/0	34 (3–65)
				RFA	43	62.2 (50.3-74.1)	76.7	52	23.0 (14.9-31.1)	39/4/0	40 (5–126)
Chinnaratha et al[40], 2014	Retro	Australia	2006-2012	MWA	101	62.1 (51.7-72.5)	98	NR	21.1 (10.9-31.3)	92/23/2	36
				RFA	25	62.1 (51.7-72.5)	98		21.1 (10.9-31.3)		36
Cillo et al[41], 2014	Pros/Retro	Italy	2004-2010	MWA	42	64 (47–81)	83	50	NR		24
				RFA	100	63 (34–81)	83	NR			24
Ciruolo et al[42], 2020	Retro	Italy	2013-2019	MWA	NR	64	71.7	78	NR	NR	NR
				RFA				172
Ding et al[43], 2013	Retro	China	2006-2010	MWA	113	59.06 (30–86)	75.2	131	25.5 (8–50)	75/38/0	18.3 (3–51.4)
				RFA	85	58.64 (40–77)	80	98	23.8 (10–48)	49/36/0	27.7 (4–60)
Du et al[44], 2020	Retro	China	2014-2016	MWA	218	56.3 (46.3-66.3)	80	136	24 (13-35)	107/8/0	28 (15-51)
				RFA	234	57.5 (48-67)	76.5	137	26 (15-37)	105/10/0
Gaia et al[45], 2021	Retro	Italy	2013-2019	MWA	81	67 (57–73)	76.5	77	29 (20–35)	71/10/0	20.4 (10.8-38.4)
				RFA	170	63 (56–72)	69.4	169	20 (15–25)	148/22/0	34.8 (19.2–51.6)
Ghweil et al[46], 2019	Pros	Egypt	2019	MWA	25	NR	NR	NR	NR	NR	NR
				RFA	30
Iida et al[47], 2013	Retro	Japan	2001-2012	MWA	40	70.1 (63.5-76.7)	NR	NR	20 (11-29)	NR	NR
				RFA	18	73.5 (69.5-77.5)			21 (16-26)
Ding et al[48], 2013	Retro	China	2002-2011	MWA	556	58.4 (48.1-68.7)	74.8	1090	23 (12-34)	466/167/22	(6-75)
				RFA	323	58 (47.8-68.3)	79.8	562	22.8 (11.7-33.9)	248/106/22	(6-75)
Kuang et al[49], 2011	Pros	China	1997-2008	MWA	19	55 (27-74)	94	NR	NR	77/4 /0	45 (24-155)
				RFA	31
Kumbar et al[50], 2018	Retro	India	2018	MWA	25	(40-85)	92	33	NR	13/8/4	15
				RFA	25		88	35		17/8/0
Lee et al[51], 2017	Retro	Hong Kong	2003-2011	MWA	26	62.5 (49-79)	73.1	28	37.5 (20-60)	23/3/0	47.5 (11.3-62.5)
				RFA	47	58 (43-77)	85.1	52	31 (20-60)	42/5/0	52.9 (3.6-121.8)
Liu et al[52], 2018	Retro	China	2002-2017	MWA	126	54 (45, 60)	90.5	162	22.5 (17, 29)	NR	36.8 (1-115)
				RFA	436	56 (46, 65)	89.7	482	23.0 (18, 30)		34.1 (1-171)
Loriaud et al[53], 2018	Retro	France & Switzerland	2007-2015	MWA	NR	69 (61–75)	92.5	40	22.5 (10–47)	40/0/0	28 (10-46)
				RFA		67 (58-74)	85.8	120	21.3 (10-46)	111/9/0
Lu et al[54], 2005	Retro	China	1997-2002	MWA	49	50.1 (24–74)	89.8	98	25 (9–72)	22/27/0	25.1 (2.0–50.6)
				RFA	53	54.5 (20–74)	81.1	72	26 (10–61)	47/6/0	24.8 (2.0–51.0)
Mocan et al[55], 2017	Retro	Romania	2010-2016	MWA	NR	NR	NR	22	NR	NR	12 (5.6-18.4)
				RFA				79			22.8 (7.8-37.4)
Nocerino et al[56], 2016	Retro	Italy	2016	MWA	106	NR	NR	134	20.4 (11-37)	NR	12 (5.6-18.4)
				RFA	27			35	20.1 (7-34)		22.8 (7.8-37.4)
Ohmoto et al[57], 2008	Retro	Japan	2002-2006	MWA	49	64 (38–75)	83.7	56	17 (8–20)	31/14/4	33.5 (9.8-57.2)
				RFA	34	67 (44–78)	73.5	37	16 (7–20)	20/11/3	25.9 (14.6-37.2)
Potretzke et al[58], 2016	Retro	US	2001-2013	MWA	99	61 (44–82)	81.8	136	22 (20–23)	NR	24
				RFA	55	62 (23–88)	72.7	69	24 (22–26)		31
Sakaguchi et al[59], 2009	Pros	Japan	2009	MWA	142	NR	NR	NR	NR	NR	NR
				RFA	249
Santambrogio et al[60], 2017	Retro	Italy	2009-2015	MWA	60	70 (61.7-78.3)	72	NR	21.5 (16.2-26.8)	60/0/0	31 (15–46)
				RFA	94	69 (60-78)	73		19.2 (14.2-24.2)	94/0/0
Sever et al[61], 2018	Retro	Turkey	2012-2015	MWA	20	63.6 (57.3-69.9)	65	37	28 (18-38)	14/4/2	12 (1-40)
				RFA	20	64.3 (55.3-73.3)	70	34	24 (13-35)	11/4/5
Shum et al[62], 2016	Retro	Hong Kong	2014-2015	MWA	22	NR	NR	NR	NR	NR	19
				RFA	44						18
Simo et al[63], 2011	Retro	US	2006-2008	MWA	13	59.6 (49–72)	54	15	23.1 (14–39)	12/7/3	7 (2.5–10.5)
				RFA	22	58 (45–79)	86	27	25.3 (12–44)	7/6/0	19 (1.5–31)
Suwa et al[64], 2021	Retro	Japan	2014-2020	MWA	72	74.9 (66.5-83.3)	65.3	NR	17.7 (10.9-24.5)	58/14/0	12
				RFA	72	74.4 (65.2-83.6)	68.1	NR	17.6 (11.3-23.9)	61/11/0	37.8
Suwa et al[65], 2020	Retro	Japan	2016-2019	MWA	44	73.4 (65.7-81.1)	68	52	17.2 (12.3-22.1)	12/3/29	NR
				RFA	55	73.4 (65.7-81.1)	80	70	17.7 (11.3-24.1)	16/8/31
Vogl et al[66], 2015	Retro	Egypt	2008-2010	MWA	28	60 (45-68)	82.1	32	36 (9-50)	NR	NR
				RFA	25	57 (40-64)	76	36	32 (8-45)
Xu et al[67], 2004	Retro	China	1997-2001	MWA	54	53.4 (24–74)	86.6	112	25 (15-36)	53/33/11	27.4 (2–53)
				RFA	43			78	26 (12-40)
Xu et al[68], 2017	Retro	China	2007-2012	MWA	301	54.2 (43.2-65.2)	78.1	NR	17 (14-20)	278/23/0	53 (8–98)
				RFA	159	54.0 (43-65)	83		17 (14-20)	140/19/0	62 (6–102)
Yin et al[69], 2009	Retro	China	1997-2007	MWA	49	53 (41-65)	87.2	NR	39 (31-47)	NR	22 (2.2-93.5)
				RFA	59
Zhang et al[70], 2013	Retro	China	2006	MWA	77	54 (26–76)	70.2	105	NR	77/0/0	24.5 (6–64)
				RFA	78	54 (30–80)	82.1	93		78/0/0	26.3 (7–65.6)
Zhang et al[71], 2014	Pros	China	2014	MWA	45	NR	NR	60	NR	NR	NR
				RFA	56			68

CPC: Child Pugh Score; MWA: Microwave ablation; NP: Number of patients; NL: Number of lesions, NR: Not reported; RFA: Radiofrequency ablation.

Table 2 Summary of the comparison of OS and local recurrence rates between microwave ablation versus radiofrequency ablation for intrahepatic hepatocellular lesions in both cohort studies and RCTs according to year of follow-up

Endpoint	Study design	No. of studies	OR	95%CI	P for significance	I²	P for heterogeneity
Overall survival – OR
1Y	Prospective	1	3.00	0.33-27.48	0.331	-	-
	Retrospective	11	1.19	0.71-1.99	0.513	0	0.72
	RCT	4	1.95	0.71-5.34	0.194	35.5	0.20
2Y	Retrospective	7	1.27	0.75-2.18	0.377	36.6	0.15
	RCT	1	1.84	0.54-6.28	0.333	-	-
3Y	Prospective	1	1.69	0.59-4.81	0.328	-	-
	Retrospective	9	1.14	0.75-1.73	0.554	58.1	0.01
	RCT	2	0.98	0.62-1.54	0.929	0	0.62
4Y	Retrospective	5	0.77	0.46-1.29	0.323	60.8	0.04
5Y	Prospective	2	1.49	0.31-7.22	0.620	71.2	0.06
	Retrospective	5	0.86	0.62-1.19	0.357	34.8	0.19
	RCT	2	0.79	0.50-1.15	0.197	0	0.76
Unspecified	Retrospective	4	1.54	1.15-2.05	0.004	0	0.50
	RCT	2	1.47	0.73-2.96	0.282	0	0.50
Local recurrence rate – OR
1Y	Retrospective	4	0.78	0.29-2.11	0.619	62.8	0.04
	RCT	3	1.09	0.39-3.05	0.872	0	0.40
2Y	Retrospective	4	1.00	0.40-2.45	0.992	76.2	0.06
	RCT	2	1.02	0.23-4.58	0.975	70.4	0.07
3Y	Retrospective	2	0.80	0.11-5.97	0.826	84.8	0.01
	RCT	1	0.73	0.30-1.8	0.493	-	-
4Y	Retrospective	2	2.14	1.12-4.07	0.021	0	0.86
5Y	Prospective	1	2.22	0.49-10.02	0.301	-	-
	RCT	1	0.52	0.30-0.91	0.023	-	-
Unspecified	Prospective	3	0.60	0.25-1.39	0.233	0	0.44
	Retrospective	20	0.67	0.51-0.87	0.002	37.2	0.05
		1	0.26	0.06-1.07	0.063	-	-

OS: Overall survival; OR: Odds ratio; CI: Confidence interval; RCT: Randomised controlled trial.

Table 3 Summary of the comparison of median and mean overall survival rates between microwave ablation versus radiofrequency ablation for intrahepatic hepatocellular carcinoma lesions in both cohort studies and randomised controlled trials

Year	MWA sample size	RFA sample size	Median OS		P value
Year	MWA sample size	RFA sample size	MWA	RFA
1	1135	1623	96.2%	95.4%	0.31
2	651	789	90.7%	88.0%	0.10
3	1004	1480	80.5%	75.3%	0.002
4	421	464	76.8%	70.0%	0.02
5	764	1221	67.3%	69.5%	0.30

OS: Overall survival; MWA: Microwave ablation; RFA: Radiofrequency ablation.

Table 4 Summary of overall survival and local recurrence rate HRs

Endpoint	Study design	No. of studies	HR	95%CI	P for significance	I²	P for heterogeneity
Overall survival – HR
Univariate	Retrospective	2	1.17	0.75-1.83	0.497	17.5	0.27
Multivariate	Retrospective	3	1.32	0.92-1.89	0.130	0.8	0.36
Unspecified	Prospective	1	1.45	0.96-2.19	0.078	-	-
	Retrospective	13	1.06	0.86-1.32	0.580	58.6	0.004
	RCT	4	1.34	0.97-1.86	0.079	0	0.58
Local recurrence rate – HR
Univariate	Retrospective	3	1.77	0.81-3.88	0.151	63.9	0.06
Multivariate	Retrospective	2	1.88	0.79-4.47	0.151	56.1	0.13
Cox proportional	Retrospective	1	2.17	1.04-4.50	0.040	-	-
Fine and gray	Retrospective	1	2.07	0.95-4.26	0.070	-	-
Unspecified	Retrospective	1	2.00	0.50-8.00	0.326	-	-

HR: Hazard ratio; CI: Confidence interval; RCT: Randomised controlled trial.

Table 5 Microwave ablation versus radiofrequency ablation for hepatocellular lesions: Meta-analysis of adverse events

Adverse event	No. of studies	OR	95%CI	P for significance	I²		P for heterogeneity
Liver-related morbidity	11	1.51	0.64-3.55	0.342		0	0.91
Postprocedural infections	19	1.3	0.85-1.97	0.222		0	0.83
Postprocedural bleeding	10	2.36	0.92-6.07	0.075		0	0.97
Bile duct injury	5	1.88	0.57-6.23	0.299		0	0.99
Respiratory events	14	1.99	1.07-3.71	0.03		0	0.87
Local events	4	1.62	0.49-5.36	0.426		0	0.57

Liver related morbidity: Decompensation, jaundice, infarction, and portal vein thrombosis; Post-procedural infections: General, peritonitis, and liver abscess. Local events: Burns, pain, and wound complication; Respiratory events: Pleural effusion and pneumothorax. OR: Odds ratio; CI: Confidence interval.

Citation: Tang MJ, Eslick GD, Lubel JS, Majeed A, Majumdar A, Kemp W, Roberts SK. Outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma: A systematic review and meta-analysis. World J Meta-Anal 2022; 10(4): 220-237
URL: https://www.wjgnet.com/2308-3840/full/v10/i4/220.htm
DOI: https://dx.doi.org/10.13105/wjma.v10.i4.220