Radiofrequency ablation with or without transarterial chemoembolization for hepatocellular carcinoma: A systematic review and meta-analysis

Table 1 Characteristics of the included studies in this meta-analysis by treatment arms

Ref.	Arms	No. of patients	Male gender	Age (yr)	Child–Pugh Class (A/B/C)	Tumor size, cm	No. of tumors (1 vs ≥ 2)	Follow-up (mo)	OS rate (%)			RFS rate, %
									1-yr	3-yr	5-yr	1-yr	3-yr	5-yr
Zhang et al[9]	RFA + TACE	15	12	57.8 ± 11.0	--	4.6 ± 1.3	--	24	100	NA	NA	92.3	NA	NA
				(39-72)		(2.3-7.1)
	RFA	15	13	58.3 ± 12.7	--	4.2 ± 1.1	--	24	80	NA	NA	--	NA	NA
				(38-78)		(2.4-6.0)
Shen et al[10]	IRFAPA	18	5	52.7	4/14/0	5.6	0/18	28.3	87.5	52.2	NA	63.9	50.0	NA
				(20-72)		(2.2-15.8)		(6-38)
	RFA	16	3	56.1	6/10/0	5.0	3/13	19.3	73.3	20.4	NA	30.0	18.7	NA
				(36-75)		(2.3-12.3)		(5-36)
Kang et al[11]	RRA + TACE	19	14	52.2	12/7/0	6.7 ± 1.1	--	36	84.2	36.8	NA	--	--	NA
	RFA	18	14	50.7	12/6/0	6.2 ± 1.2	--	36	61.1	16.7	NA	--	--	NA
Kobayashi et al[12]	RFA + AO	10	7	67	4/5/1	1.7	--	48	--	--	NA	87.5	25	NA
				(50-76)		(1.0-2.4)
	RFA	10	8	63	3/5/2	2.3	--	48	--	--	NA	70.0	20	NA
				(51-75)		(1.0-2.6)
Yang et al[13]	RFA + TACE	31	23	60.3 ± 10.9	--	6.5 ± 0.8	--	--	81.2	--	--	--	82.2	--
	RFA	12	8	61.0 ± 10.4	--	5.2 ± 0.4	--	--	57.6	--	--	--	65.3	--
Shibata et al[14]	RFA + TACE	46	31	67.2 ± 8.9	32/14/0	1.7 ± 0.6	43/3	60	100	84.8	--	71.3	48.8	--
				(45-83)		(0.9-3.0)
	RFA	43	33	69.8 ± 8.0	33/10/0	1.6 ± 0.5	42/1	60	100	84.5	--	74.3	29.7	--
				(44-87)		(0.8-2.6)
Morimoto et al[15]	RFA + TACE	19	15	70	18/1/0	3.7 ± 0.6	--	30 (12-46)	100	93	NA	67	--	9
				(57-78)
	RFA	18	12	73	16/2/0	3.6 ± 0.7	--	32 (15-46)	89	80	NA	56	--	28
				(48-84)
Peng et al[8]	RFA + TACE	69	59	57.5 ± 10.0	60/9/0	2.1 ± 0.5	65/4	39.2	94	69	46	80	45	40
				(19-75)		(0.8-5.0)		(5.0-95.0)
	RFA	70	55	55.1 ± 9.5	59/11/0	2.1 ± 0.4	65/5	33.6	82	47	36	64	18	18
				(22-75)		(0.9-5.0)		(2.0-87.0)
Peng et al[7]	RFA + TACE	94	75	53.3 ± 11.0	90/4/0	3.5 ± 1.4	62/32	60	92.6	66.6	--	79.4	66.7	--
	RFA	95	71	55.3 ± 13.3	90/5/0	3.4 ± 1.4	67/28	60	85.3	59.0	--	60.6	44.2	--

AO: Arterial occlusion; IRFAPA: Intraoperative radiofrequency thermal ablation with portal vein infusion chemotherapy and transarterial chemoembolization; NA: Not applicable; TACE: Transarterial chemoembolization; RFA: Radiofrequency ablation.

Table 2 Stratified analysis of the pooled associations for overall survival and radiofrequency ablation rates comparing transarterial chemoembolization/radiofrequency ablation with radiofrequency ablation alone

Outcome	Potential modifiers		No. of studies	No. of events/patients		Heterogeneity test	RR (95%CI)
				RFA + TACE	RFA
1-yr OS rate	Tumor size, cm	< 3	1	65/69	59/70	NA	1.12 (0.99, 1.26)
		3–5	3	121/128	109/128	I2 = 0.0%, P = 0.66	1.11 (1.02, 1.21)1
		> 5	3	57/68	30/46	I2 = 0.0%, P = 0.80	1.28 (1.02, 1.61)1
	Study location	China	5	208/227	171/208	I2 = 0.0%, P = 0.77	1.12 (1.04, 1.20)1
		Japan	2	35/38	27/36	I2 = 11.2%, P = 0.29	1.17 (0.96, 1.43)
3-yr OS rate	Tumor size, cm	< 3	2	87/115	69/113	I2 = 83.2%, P = 0.02	1.21 (0.79, 1.83)
		3–5	2	81/113	70/113	I2 = 0.0%, P = 0.68	1.17 (0.99, 1.39)1
		> 5	2	18/37	9/34	I2 = 0.0%, P = 0.66	1.77 (0.95, 3.31)
	Study location	China	3	122/181	95/181	I2 = 18.7%, P = 0.29	1.29 (1.05, 1.58)1
		Japan	3	64/84	53/79	I2 = 33.4%, P = 0.22	1.12 (0.90, 1.39)
1-yr	Tumor size, cm	< 3	3	102/125	88/123	I2 = 10.7%, P = 0.33	1.11 (0.96, 1.28)
RFS rate		3–5	2	88/113	68/113	I2 = 0.0%, P = 0.83	1.30 (1.09, 1.55)1
		> 5	1	11/18	5/16	NA	1.96 (0.87, 4.42)
	Study location	China	3	141/181	108/181	I2 = 0.0%, P = 0.55	1.29 (1.12, 1.49)1
		Japan	3	60/75	53/71	I2 = 0.0%, P = 0.70	1.04 (0.89, 1.23)
3-year	Tumor size, cm	< 3	3	67/128	47/123	I2 = 84.3%, P < 0.01	1.45 (0.59, 3.54)
RFS rate		3–5	1	63/94	42/95	NA	1.52 (1.16, 1.98)1
		> 5	2	34/49	11/28	I2 = 51.0%, P = 0.15	1.56 (0.70, 3.47)
	Study location	China	4	128/212	66/193	I2 = 41.2%, P = 0.16	1.63 (1.19, 2.24)1
		Japan	2	36/59	34/53	I2 = 0.0%, P = 0.52	0.90 (0.71, 1.19)

¹Denotes significant or marginally significant. TACE: Transarterial chemoembolization; RFA: Radiofrequency ablation.