Intervention Review

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Radiofrequency (thermal) ablation versus no intervention or other interventions for hepatocellular carcinoma

  1. Sebastian Weis1,*,
  2. Annegret Franke2,
  3. Joachim Mössner1,
  4. Janus C Jakobsen3,
  5. Konrad Schoppmeyer4

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 19 DEC 2013

Assessed as up-to-date: 19 SEP 2012

DOI: 10.1002/14651858.CD003046.pub3


How to Cite

Weis S, Franke A, Mössner J, Jakobsen JC, Schoppmeyer K. Radiofrequency (thermal) ablation versus no intervention or other interventions for hepatocellular carcinoma. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD003046. DOI: 10.1002/14651858.CD003046.pub3.

Author Information

  1. 1

    University of Leipzig, Division of Gastroenterology and Rheumatology Department of Internal Medicine, Neurology and Dermatology, Leipzig, Germany

  2. 2

    Universität Leipzig, Zentrum für Klinische Studien (ZKS) Leipzig, Leipzig, Germany

  3. 3

    Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, The Cochrane Hepato-Biliary Group, Copenhagen, Sjælland, Denmark

  4. 4

    Euregio-Klinik GmbH, Internal Medicine, Nordhorn, Germany

*Sebastian Weis, Division of Gastroenterology and Rheumatology Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Liebigstrasse 20, Leipzig, 04103, Germany. sebastian.weis@medizin.uni-leipzig.de.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 19 DEC 2013

SEARCH

[Figure 1]
Figure 1. Study flow diagram of the literature search as well as number and reasons of excluded studies.
[Figure 2]
Figure 2. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies (survival outcomes).
[Figure 3]
Figure 3. Risk of bias summary: review authors' judgements about each risk of bias item for each included study (survival outcomes).
[Figure 4]
Figure 4. Trial sequential analysis for the comparison radiofrequency ablation versus hepatic resection on mortality in patients with hepatocellular carcinoma.

The diversity-adjusted required information size (DARIS) was calculated based upon a proportion of deaths of 30% in the percutaneous ethanol injection group (PEI); a relative risk reduction (RRR) of 20%; an alpha of 5% (a); a beta of 20% (b); and an assumed squared diversity (D) of 30%. The cumulative Z-score never crossed the alpha-spending monitoring boundary for harm and did not reach the beta-spending monitoring boundaries (the area of futility), which was not even drawn by the program. Therefore, further randomised trials are needed.
[Figure 5]
Figure 5. Trial sequential analysis for the comparison radiofrequency ablation versus percutaneous ethanol injection group (PEI) on mortality in patients with hepatocellular carcinoma. The diversity-adjusted required information size (DARIS) was calculated based upon a proportion of deaths of 30% in the PEI group; a relative risk reduction (RRR) of 20%; an alpha of 5% (a); a beta of 20% (b); and an assumed squared diversity (D) of 30%. As it can be seen, the cumulative Z-score has never crossed the alpha-spending monitoring boundary for benefit and has not reached the beta-spending monitoring boundary (the area of futility). Therefore, further randomised trials are needed.
[Analysis 1.1]
Analysis 1.1. Comparison 1 Overall survival, Outcome 1 Overall survival: control interventions versus RFA.
[Analysis 1.2]
Analysis 1.2. Comparison 1 Overall survival, Outcome 2 Fixed-effect model.
[Analysis 1.3]
Analysis 1.3. Comparison 1 Overall survival, Outcome 3 Trials with low risk of bias.
[Analysis 1.4]
Analysis 1.4. Comparison 1 Overall survival, Outcome 4 Resection versus RFA, dichotomous outcome.
[Analysis 1.5]
Analysis 1.5. Comparison 1 Overall survival, Outcome 5 PEI or PAI versus RFA.
[Analysis 2.1]
Analysis 2.1. Comparison 2 Two-year survival, Outcome 1 Control interventions versus RFA.
[Analysis 2.2]
Analysis 2.2. Comparison 2 Two-year survival, Outcome 2 Resection versus RFA, low risk of bias trials.
[Analysis 2.3]
Analysis 2.3. Comparison 2 Two-year survival, Outcome 3 PEI or PAI versus RFA, low risk of bias trials.
[Analysis 3.1]
Analysis 3.1. Comparison 3 Event-free survival, Outcome 1 Event-free survival: control interventions versus RFA.
[Analysis 3.2]
Analysis 3.2. Comparison 3 Event-free survival, Outcome 2 PEI or PAI versus RFA, low risk of bias trials.
[Analysis 4.1]
Analysis 4.1. Comparison 4 Local progression/recurrences, Outcome 1 Local progression: control intervention versus RFA.
[Analysis 5.1]
Analysis 5.1. Comparison 5 Other secondary outcomes, Outcome 1 Rate of complications: RFA versus other interventions.
[Analysis 5.2]
Analysis 5.2. Comparison 5 Other secondary outcomes, Outcome 2 Rate of complications: PEI or PAI versus RFA.
[Analysis 5.3]
Analysis 5.3. Comparison 5 Other secondary outcomes, Outcome 3 PEI/PAI versus RFA, low risk of bias trials.
[Analysis 5.4]
Analysis 5.4. Comparison 5 Other secondary outcomes, Outcome 4 Length of hospital stay; control interventions versus RFA (days).
[Analysis 5.5]
Analysis 5.5. Comparison 5 Other secondary outcomes, Outcome 5 Length of hospital stay; PEI or PAI versus RFA (days).
[Analysis 6.1]
Analysis 6.1. Comparison 6 PEI or PAI versus RFA, overall survival, other, Outcome 1 PEI versus RFA, dichotomous outcome.
[Analysis 6.2]
Analysis 6.2. Comparison 6 PEI or PAI versus RFA, overall survival, other, Outcome 2 PEI/PAI versus RFA, low risk of bias trials.
[Analysis 6.3]
Analysis 6.3. Comparison 6 PEI or PAI versus RFA, overall survival, other, Outcome 3 PEI versus RFA, Italian versus Asian trials.