Unraveling the Controversy: Transarterial Chemoembolization versus Radiofrequency Ablation in Early Hepatocellular Carcinoma - A Systematic Review and Meta-Analysis

Abstract

Abstract Background Patients with hepatocellular carcinoma (HCC) may face challenges when undergoing radiofrequency ablation (RFA) if their tumors are located near critical liver regions, bile ducts, bowel lumen, or diaphragm due to increased risk of complications. In these cases, liver resection or transplantation is not possible; therefore, transarterial chemoembolization (TACE) can be an alternative treatment for early HCC patients. Our study aims to compare the efficacy and safety of TACE versus RFA. Methods We collected data from different sources, including Cochrane Library, PubMed, Scopus, and Web of Science. Our inclusion criteria were patients with a single tumor less than 5 cm or three tumors, each less than or equal to 3 cm in size, without spread or invasion. The review examined various factors such as overall survival (OS), recurrence-free survival rate (RFS), progression-free survival (PFS), tumor response (TR), and adverse event rate (AER). Results Eighteen studies, involving 4,537 patients were reviewed. Pooled analysis revealed that RFA had better three-year and five-year OS rates compared to TACE (RR = 0.85, 95% CI [0.78, 0.92], p < 0.00001; RR = 0.80, 95% CI [0.73, 0.89], p < 0.0001, respectively). However, for one-year OS, no significant difference was observed, except in specific subgroups (patients aged ≥ 60 years, AFP ≥ 100 ng/ml, or received Adriamycin), where RFA showed better outcomes (RR = 1.02, 95% CI [0.99, 1.05], p = 0.29). Propensity score-matching analyses also demonstrated better three-year and five-year OS rates for RFA (RR = 0.91, 95% CI [0.85, 0.96], p = 0.001; RR = 0.85, 95% CI [0.79, 0.92], p < 0.001, respectively).